Provider Demographics
NPI:1376624130
Name:DERDERIAN, KRISTIN M (DO)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:DERDERIAN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1862
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:28080 GRAND RIVER AVE STE 306
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5966
Practice Address - Country:US
Practice Address - Phone:947-521-8314
Practice Address - Fax:248-478-8864
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-10-27
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Provider Licenses
StateLicense IDTaxonomies
MI5101013350207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease