Provider Demographics
NPI:1285094706
Name:QUINN, KATHLEEN ANNE (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:QUINN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11885 E 12 MILE RD
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3474
Mailing Address - Country:US
Mailing Address - Phone:586-582-7090
Mailing Address - Fax:586-582-7091
Practice Address - Street 1:11885 E 12 MILE RD
Practice Address - Street 2:SUITE 202A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3474
Practice Address - Country:US
Practice Address - Phone:586-582-7090
Practice Address - Fax:586-582-7091
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101025449207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program