Healthcare Provider Details

I. General information

NPI: 1710879937
Provider Name (Legal Business Name): KATHRYN ROBERTS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 LEVAN RD STE 311
LIVONIA MI
48154-5085
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR STE J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-2692
  • Fax: 734-655-4218
Mailing address:
  • Phone: 734-747-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1032874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: