Healthcare Provider Details

I. General information

NPI: 1891499653
Provider Name (Legal Business Name): KATHRINE ED YACOO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 SCHOENHERR RD STE 400
WARREN MI
48088-6684
US

IV. Provider business mailing address

27450 SCHOENHERR RD STE 400
WARREN MI
48088-6684
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7550
  • Fax: 586-582-7515
Mailing address:
  • Phone: 586-582-7550
  • Fax: 586-582-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: