Healthcare Provider Details

I. General information

NPI: 1053453001
Provider Name (Legal Business Name): KATHLEEN A LINDHOUT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 GRANDVILLE AVE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

245 STATE ST SE STE 1A
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8400
  • Fax: 616-742-1322
Mailing address:
  • Phone: 616-685-8050
  • Fax: 616-685-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002266
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: