Provider Demographics
NPI:1962725556
Name:KUYKENDALL, ANN MARIE (PAC)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 W MAPLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2271
Mailing Address - Country:US
Mailing Address - Phone:248-932-9223
Mailing Address - Fax:248-932-8641
Practice Address - Street 1:5777 W MAPLE RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2271
Practice Address - Country:US
Practice Address - Phone:248-932-9223
Practice Address - Fax:248-932-8641
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002554363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601002554OtherSTATE LICENSE