Individual
DR. KIMBERLY ROSE COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
29000 LITTLE MACK AVE STE B, SAINT CLAIR SHORES, MI 48081-3018
(586) 774-8811
(586) 541-0199
Mailing address
22101 MOROSS RD, DETROIT, MI 48236-2148
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
309316
NY
208600000X
Surgery Physician
Primary
4301506652
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301109635
MI
Other
Enumeration date
06/16/2016
Last updated
06/21/2022
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