Provider Demographics
NPI:1427037282
Name:KIN, STEVEN JOE (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOE
Last Name:KIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HAGGERTY ROAD
Mailing Address - Street 2:STE 2130
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2191
Mailing Address - Country:US
Mailing Address - Phone:248-668-1104
Mailing Address - Fax:248-668-1096
Practice Address - Street 1:2300 HAGGERTY RD STE 2130
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2191
Practice Address - Country:US
Practice Address - Phone:248-668-1104
Practice Address - Fax:248-686-1096
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK010029207YX0602X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3440894OtherFEDERAL TAX ID FOR CORP.
MI4100372Medicaid
MI4100363Medicaid
MI4100372Medicaid
MIOM80250Medicare ID - Type Unspecified