Provider Demographics
NPI:1134265937
Name:KIET A DOAN DO PC
Entity type:Organization
Organization Name:KIET A DOAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIET
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-230-9600
Mailing Address - Street 1:3500 CALKINS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3506
Mailing Address - Country:US
Mailing Address - Phone:810-230-9600
Mailing Address - Fax:810-230-9607
Practice Address - Street 1:3500 CALKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3506
Practice Address - Country:US
Practice Address - Phone:810-230-9600
Practice Address - Fax:810-230-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013629208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0993273OtherHEALTHPLUS
MI5251038OtherBLUE CARE NETWORK
MI1011135OtherMCLAREN HEALTH PLAN
MIDB9081OtherMEDICARE RAILROAD
MI6U4055OtherHEALTH ALLIANCE PLAN
MI11153OtherMCARE
MA1011135OtherMCLAREN HEALTH ADVANTAGE
MIDB9081OtherMEDICARE RAILROAD
MI1011135OtherMCLAREN HEALTH PLAN