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General NPI Number Information
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NPI Number | 1003477480
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Entity Type | Individual
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Provider Name | KAITLYN DOBESH MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 05/02/2021
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2689
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Country | US
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Telephone | 313-916-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 956 NOTTINGHAM RD
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1734
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Country | US
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Telephone | 517-256-1336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4351044593
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License Number State | MI
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