Healthcare Provider Details

I. General information

NPI: 1932396264
Provider Name (Legal Business Name): KATHERINE SLOAN SCHAFER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ELIZABETH SLOAN D.O.

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E. 14 MILE RD SUITE 120
BIRMINGHAM MI
48009-1452
US

IV. Provider business mailing address

4201 ST. ANTOINE - UHC 5D MAILBOX 226 UNIVERSITY PEDIATRICIANS
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-440-3575
  • Fax:
Mailing address:
  • Phone: 313-745-4405
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101017403
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: