Individual
MRS. KELLY MCINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(248) 325-1000
Mailing address
324 N HARVEY ST, PLYMOUTH, MI 48170-1223
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004080
MI
Other
Enumeration date
04/19/2007
Last updated
02/15/2021
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