Provider Demographics
NPI:1952434276
Name:KELLY-PERKINS, MONIQUE DENISE
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:DENISE
Last Name:KELLY-PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3482
Mailing Address - Country:US
Mailing Address - Phone:313-571-9315
Mailing Address - Fax:877-212-0551
Practice Address - Street 1:5621 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3482
Practice Address - Country:US
Practice Address - Phone:313-571-9315
Practice Address - Fax:877-212-0551
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744G0900XOther Service ProvidersSpecialistGraphics Designer