Individual
MRS. KIMBERLY T CANTILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
39450 W 12 MILE RD, NOVI, MI 48377-3600
(313) 461-4632
Mailing address
39450 W 12 MILE RD, NOVI, MI 48377-3600
(313) 461-4632
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004760
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5301004760
LICENSE
MI
Enumeration date
06/28/2006
Last updated
01/28/2021
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