Healthcare Provider Details

I. General information

NPI: 1780666925
Provider Name (Legal Business Name): KATHY J BRITTAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 HEALTH PKWY SUITE B
PAW PAW MI
49079-8242
US

IV. Provider business mailing address

601 JOHN ST # 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-655-3065
  • Fax: 269-655-0585
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301054150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: