Basic Information
| Provider Information | |||||||||
| NPI: | 1407112162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 JOHN R ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005276266 | ||||||||
| FaxNumber: | 3135768381 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 JOHN R ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005276266 | ||||||||
| FaxNumber: | 3135768381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2012 | ||||||||
| LastUpdateDate: | 04/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 4301107032 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0000X | 4301107032 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
No ID Information.