1710129606 NPI number — MS. KATHERINE R HADED MHS

Table of content: MS. KATHERINE R HADED MHS (NPI 1710129606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710129606 NPI number — MS. KATHERINE R HADED MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADED
Provider First Name:
KATHERINE
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710129606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
941 SHERWOOD LAKE DR
Provider Second Line Business Mailing Address:
APARTMENT 413
Provider Business Mailing Address City Name:
SCHERERVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46375-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-825-3176
Provider Business Mailing Address Fax Number:
219-374-5624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12845 PARRISH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR LAKE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46303-9298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-374-5624
Provider Business Practice Location Address Fax Number:
219-374-5624
Provider Enumeration Date:
03/24/2009

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: 235Z00000X , with the licence number:  46001927A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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