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Contact Information

KATHRYN M POULOS
9377 N HAGGERTY RD
PLYMOUTH, MI48170
 Phone: 734-451-0070
 Fax: 734-451-1583
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KATHRYN M POULOS · (Female)

NPI # 1083988323
Status Active
Credentials
Entity Individual
Enumeration date 03/05/2012
Last updated 10/22/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • MI License # 5601006317
  • MI Other 5601006317 LICENSE
Hospital affiliation(s)
  • BOTSFORD HOSPITAL - (Acute Care)
    28050 GRAND RIVER AVENUE
    FARMINGTON HILLS, MI 48336
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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