1235496951 NPI number — DR. KATHARINE D LOUNSBERRY M.D.

Table of content: DR. KATHARINE D LOUNSBERRY M.D. (NPI 1235496951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235496951 NPI number — DR. KATHARINE D LOUNSBERRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOUNSBERRY
Provider First Name:
KATHARINE
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEORGE
Provider Other First Name:
KATHARINE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235496951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1034 W ANN ARBOR TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48170-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-667-5152
Provider Business Mailing Address Fax Number:
734-667-2579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30488 MILFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HUDSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-437-4625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301101403 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)