Provider Demographics
NPI:1396315099
Name:KAI ANDERSON, M.D., PLLC
Entity type:Organization
Organization Name:KAI ANDERSON, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-282-7968
Mailing Address - Street 1:5112 OLD BARN LN
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8279
Mailing Address - Country:US
Mailing Address - Phone:313-282-7968
Mailing Address - Fax:269-210-2503
Practice Address - Street 1:26520 GRAND RIVER AVE STE 128
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1506
Practice Address - Country:US
Practice Address - Phone:313-533-5652
Practice Address - Fax:313-533-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health