Provider Demographics
NPI:1295909067
Name:ZELIN, KATHLEEN MARY (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:ZELIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31012 DORAIS ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3204
Mailing Address - Country:US
Mailing Address - Phone:734-261-5361
Mailing Address - Fax:313-993-0894
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:CARDIOLOGY DEPT, 2ND FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-2441
Practice Address - Fax:313-993-0894
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704149520363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics