=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497778617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIM HORN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 07/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 S RAISINVILLE RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-9754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-384-8595
-----------------------------------------------------
Fax | 734-243-5506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6787 MAPLELAWN DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-1886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-999-7005
-----------------------------------------------------
Fax | 919-887-0695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 4301076615
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------