Provider Demographics
NPI:1851392427
Name:KOLIN, MYRA GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:GAIL
Last Name:KOLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:36700 WOODWARD AVE
Mailing Address - Street 2:300
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0926
Mailing Address - Country:US
Mailing Address - Phone:248-203-6620
Mailing Address - Fax:248-203-0093
Practice Address - Street 1:1800 W. BIG BEAVER RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-205-3535
Practice Address - Fax:248-649-5920
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301-065159208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3307137Medicaid
F20127Medicare UPIN
OM23730Medicare ID - Type Unspecified