Individual
DR. KATHLEEN MARY KALIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D, LP
Contact information
Practice address
24940 FAIRMOUNT DR, DEARBORN, MI 48124-1584
(313) 274-3500
Mailing address
24940 FAIRMOUNT DR, DEARBORN, MI 48124-1584
(313) 274-3500
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301003906
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OF33321
BLUE CROSS PROVIER NUMBER
MI
Enumeration date
03/22/2007
Last updated
07/08/2007
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