Healthcare Provider Details

I. General information

NPI: 1396315099
Provider Name (Legal Business Name): KAI ANDERSON, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 GRAND RIVER AVE STE 128
REDFORD MI
48240-1506
US

IV. Provider business mailing address

5112 OLD BARN LN
CLIO MI
48420-8279
US

V. Phone/Fax

Practice location:
  • Phone: 313-533-5652
  • Fax: 313-533-5644
Mailing address:
  • Phone: 313-282-7968
  • Fax: 269-210-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAI ANDERSON
Title or Position: OWNER
Credential: MD
Phone: 313-282-7968