Healthcare Provider Details

I. General information

NPI: 1013003755
Provider Name (Legal Business Name): CATHERINE E SHIREK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE E HOULE MD

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

IV. Provider business mailing address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

V. Phone/Fax

Practice location:
  • Phone: 701-567-4561
  • Fax:
Mailing address:
  • Phone: 701-567-4561
  • Fax: 701-567-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5862
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: