Provider Demographics
NPI:1699848952
Name:KITTLE, KIM (CNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KITTLE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:461 W HURON ST
Mailing Address - Street 2:DEPARTMENT OF OB GYN
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-857-7316
Mailing Address - Fax:248-857-6985
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0166
Practice Address - Country:US
Practice Address - Phone:248-334-4505
Practice Address - Fax:248-334-4517
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704125426363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology