Provider Demographics
NPI:1306815089
Name:KINNER, CAROLANN KIM (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLANN
Middle Name:KIM
Last Name:KINNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29703 HOOVER RD
Mailing Address - Street 2:STE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-8901
Mailing Address - Country:US
Mailing Address - Phone:586-558-4081
Mailing Address - Fax:586-558-4082
Practice Address - Street 1:29703 HOOVER RD
Practice Address - Street 2:STE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2544
Practice Address - Country:US
Practice Address - Phone:586-558-4081
Practice Address - Fax:586-558-4082
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICK012324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4494030 11Medicaid
MI130255OtherCARE CHOICES
MI5441662OtherAETNA
MI1185263OtherFIRST HEALTH
MI1316097942OtherUNITED HEALTH
MIG75704OtherHEALTH ALLIANCE PLAN
MI0E01338OtherBCBSM
MI320018015 51OtherPPOM
MI320018015 51OtherPPOM
MI0E01338OtherBCBSM