Provider Demographics
NPI:1326165481
Name:DE BIN, KATHLEEN L (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:DE BIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17197 N LAUREL PARK DR
Mailing Address - Street 2:SUITE 161
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2680
Mailing Address - Country:US
Mailing Address - Phone:734-338-8300
Mailing Address - Fax:734-338-8301
Practice Address - Street 1:17197 N LAUREL PARK DR
Practice Address - Street 2:SUITE 161
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2680
Practice Address - Country:US
Practice Address - Phone:734-338-8300
Practice Address - Fax:734-338-8301
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H231390OtherBCBS GROUP NUMBER
MI0P47270Medicare PIN