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General NPI Number Information
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NPI Number | 1699690727
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Entity Type | Individual
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Provider Name | KASMIRE BAO-TRAN M PHAM RN, NP STUDENT
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Gender | Female
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 21885 S TULLER CT
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City | SOUTHFIELD
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State | MI
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Zip | 48076-4836
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Country | US
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Telephone | 248-938-3386
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Fax | 248-809-3696
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Provider Business Mailing Address
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Address Line | 21885 S TULLER CT
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City | SOUTHFIELD
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State | MI
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Zip | 48076-4836
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Country | US
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Telephone | 248-938-3386
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Fax | 248-809-3696
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 4704325940
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License Number State | MI
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