Healthcare Provider Details

I. General information

NPI: 1306708623
Provider Name (Legal Business Name): CATHERINE ANN KLIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2059
US

IV. Provider business mailing address

PO BOX 18998
BELFAST ME
04915-4084
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5111
  • Fax: 313-745-3500
Mailing address:
  • Phone: 469-803-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704311970
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: