Provider Demographics
NPI:1245217264
Name:PITONE-LIPKIN, KATHRYN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:PITONE-LIPKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42557 WOODWARD AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-322-3088
Mailing Address - Fax:248-322-4175
Practice Address - Street 1:8391 COMMERCE RD STE 110B
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-716-3180
Practice Address - Fax:947-800-7270
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKP012470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4989370OtherMEDICARE GROUP PTAN ID
MI4893235Medicaid
MI5472348OtherBCBS PIN
MIM89900040Medicare PIN
F36003009Medicare ID - Type Unspecified
MI4893235Medicaid