Healthcare Provider Details

I. General information

NPI: 1235750373
Provider Name (Legal Business Name): KATHERINE MARIE OBUDZINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32100 TELEGRAPH RD
BINGHAM FARMS MI
48025-2452
US

IV. Provider business mailing address

141 HENDRIE BLVD
ROYAL OAK MI
48067-2412
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-1221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: