Individual
MS. KRISTEN ANN FORMOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4440 LAPHAM ST, DEARBORN, MI 48126-3473
(313) 969-6210
Mailing address
4440 LAPHAM ST, DEARBORN, MI 48126-3473
(313) 969-6210
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
6801095545
MI
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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