Basic Information
| Provider Information | |||||||||
| NPI: | 1891437869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KMITA | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10728 MELBOURNE AVE | ||||||||
| Address2: | |||||||||
| City: | ALLEN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481011116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135804698 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47601 GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483741233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484654100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2022 | ||||||||
| LastUpdateDate: | 04/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5601011097APP22 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.