Healthcare Provider Details

I. General information

NPI: 1497778617
Provider Name (Legal Business Name): KIM HORN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S RAISINVILLE RD
MONROE MI
48161-9754
US

IV. Provider business mailing address

6787 MAPLELAWN DR
YPSILANTI MI
48197-1886
US

V. Phone/Fax

Practice location:
  • Phone: 734-384-8595
  • Fax: 734-243-5506
Mailing address:
  • Phone: 734-999-7005
  • Fax: 919-887-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301076615
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: