Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4351044593 | MI |
Y | 208600000X | Surgeon | 4351044593 | MI |
NPI | 1003477480 |
---|---|
Provider Name | Kaitlyn Dobesh |
First Address | Grosse Pointe Park, MI 48230-1734 |
Second Address | Detroit, MI 48202-2689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 02/05/2021 |