MEDICARE: DR. KATHLEEN MARIE NORTH-WILHELM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00019917	WA

General Provider Information

NPI Number	:	1952389017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MARIE NORTH-WILHELM M.D.

Provider Business Mailing Address
First Line	:	2885 SANFORD BLVD. #24486
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 E CAMELBACK RD
Second Line	:	SUITE 210
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4764
Country	:	US
Telephone Number	:	602-626-7262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	04/03/2013

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