Basic Information
| Provider Information | |||||||||
| NPI: | 1962775361 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35046 WOODWARD AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480090964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486479860 | ||||||||
| FaxNumber: | 2486479864 | ||||||||
| Practice Location | |||||||||
| Address1: | 35046 WOODWARD AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480090964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486479860 | ||||||||
| FaxNumber: | 2486479864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2012 | ||||||||
| LastUpdateDate: | 01/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 5601006299 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.