1639224280 NPI number — MRS. KATHLEEN L DOOLEY RD, CDE

Table of content: MRS. KATHLEEN L DOOLEY RD, CDE (NPI 1639224280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639224280 NPI number — MRS. KATHLEEN L DOOLEY RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOOLEY
Provider First Name:
KATHLEEN
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
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:
1639224280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36475 5 MILE RD
Provider Second Line Business Mailing Address:
COMMUNITY OUTREACH DEPT.
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48154-1971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-655-8956
Provider Business Mailing Address Fax Number:
734-655-4254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 FRANK LLOYD WRIGHT DR.
Provider Second Line Business Practice Location Address:
PO BOX 0446 LOBBY J
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48106-0446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-747-6766
Provider Business Practice Location Address Fax Number:
734-222-3100
Provider Enumeration Date:
01/24/2007

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: 133V00000X , with the licence number:  11832 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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