Provider Demographics
NPI:1508070475
Name:KIBA, DEANNE ELIZABETH (DO, FAARFM)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:ELIZABETH
Last Name:KIBA
Suffix:
Gender:F
Credentials:DO, FAARFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6436 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48094-1238
Mailing Address - Country:US
Mailing Address - Phone:330-988-2207
Mailing Address - Fax:
Practice Address - Street 1:543 N MAIN ST STE 122
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1485
Practice Address - Country:US
Practice Address - Phone:248-601-5055
Practice Address - Fax:248-659-1639
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8892207Q00000X
MI3307946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine