Individual
BONI S KOITHARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
311 MACK AVE, DETROIT, MI 48201-2466
(313) 745-3000
Mailing address
311 MACK AVE, DETROIT, MI 48201-2466
(313) 745-3000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704237388
MI
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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