1902857469 NPI number — KATHERINE J. ASHMORE N.P.

Table of content: KATHERINE J. ASHMORE N.P. (NPI 1902857469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902857469 NPI number — KATHERINE J. ASHMORE N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHMORE
Provider First Name:
KATHERINE
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEWART
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902857469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2799 W GRAND BOULEVARD
Provider Second Line Business Mailing Address:
K14 CARDIOLOGY
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-461-9110
Provider Business Mailing Address Fax Number:
313-916-8416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2799 W GRAND BOULEVARD
Provider Second Line Business Practice Location Address:
K14 CARDIOLOGY
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-461-9110
Provider Business Practice Location Address Fax Number:
313-916-8416
Provider Enumeration Date:
05/12/2006

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: 363LG0600X , with the licence number:  4704169669 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 4704169669 , 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)

  • Identifier: MI4989 . This is a "GROUP MEDICARE PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104517792 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00019217 . This is a "METRAHEALTH RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1295023547 . This is a "GROUP NPI TYPE II (MICHIGAN HEALTHCARE PROFESSIONALS, PC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".