Individual
KATELYN DE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22250 PROVIDENCE DR STE 500, SOUTHFIELD, MI 48075-6213
(248) 849-3441
(248) 849-5826
Mailing address
22250 PROVIDENCE DR STE 500, SOUTHFIELD, MI 48075-6213
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4351052573
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2024
Last updated
10/02/2024
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