Healthcare Provider Details

I. General information

NPI: 1255538088
Provider Name (Legal Business Name): KATHERINE O'BRIEN CASHEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN CHILDREN'S HOSPITAL OF MI
DETROIT MI
48201
US

IV. Provider business mailing address

4201 ST. ANTIONE UHC 5D UNIVERSITY PEDIATRICIANS
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5629
  • Fax: 313-966-0105
Mailing address:
  • Phone: 313-966-5051
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101017388
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number5101017388
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: