=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497065403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAIRI L HORSLEY D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2010
-----------------------------------------------------
Last Update Date | 07/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23077 GREENFIELD RD STE 255
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-559-5200
-----------------------------------------------------
Fax | 248-599-6889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23077 GREENFIELD RD STE 255
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-559-5200
-----------------------------------------------------
Fax | 248-599-6889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 5901002371
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------