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General NPI Number Information
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NPI Number | 1548680218
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Entity Type | Individual
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Provider Name | CAITLIN FLYNN PORUBSKY D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 2305 GENOA BUSINESS PARK DR STE 180
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City | BRIGHTON
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State | MI
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Zip | 48114-7007
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Country | US
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Telephone | 810-355-4300
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Fax | 810-355-4967
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Provider Business Mailing Address
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Address Line | 43151 DALCOMA DR STE 4
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6306
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Country | US
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Telephone | 586-286-8720
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 5101025158
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License Number State | MI
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