Individual
CASEY KOLP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4160 JOHN R ST STE 930, DETROIT, MI 48201-2017
(313) 966-5007
Mailing address
23230 DETOUR ST, SAINT CLAIR SHORES, MI 48082-2028
(586) 306-1881
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007864
MI
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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