Provider Demographics
NPI:1285707133
Name:DONALD S KITAIN DO PC
Entity type:Organization
Organization Name:DONALD S KITAIN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KITAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-360-8825
Mailing Address - Street 1:9640 COMMERCE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4111
Mailing Address - Country:US
Mailing Address - Phone:248-360-8825
Mailing Address - Fax:248-360-8897
Practice Address - Street 1:9640 COMMERCE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-360-8825
Practice Address - Fax:248-360-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDK008753207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDK008753OtherPHYSICIAN LICENSE
MI102401OtherCARE CHOICES HMO PPO
MI0456330364OtherBLUE CARE NETWORK
MI01001880OtherHEALTH PLUS
MI4498389002OtherCIGNA
MI1876910Medicaid
MI4629785OtherAETNA
MIM014782OtherTRICARE HEALTHNET
MI0456330364OtherBCBS OF MICHIGAN
MI4629785OtherAETNA
MIM014782OtherTRICARE HEALTHNET
MIC01464Medicare UPIN