Healthcare Provider Details

I. General information

NPI: 1679405104
Provider Name (Legal Business Name): KINNUS PAUL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21574 HIDDEN RIVERS DR S
SOUTHFIELD MI
48075-1006
US

IV. Provider business mailing address

21574 HIDDEN RIVERS DR S
SOUTHFIELD MI
48075-1006
US

V. Phone/Fax

Practice location:
  • Phone: 313-444-3186
  • Fax:
Mailing address:
  • Phone: 313-444-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: