Healthcare Provider Details

I. General information

NPI: 1104817618
Provider Name (Legal Business Name): KWAN YEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29829 TELEGRAPH RD SUITE 100
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

29829 TELEGRAPH RD SUITE 100
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 248-355-3033
  • Fax: 248-355-4936
Mailing address:
  • Phone: 248-355-3033
  • Fax: 248-355-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberKY054913
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: