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General NPI Number Information
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NPI Number | 1447274659
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Entity Type | Individual
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Provider Name | DR. KATHLEEN M. WALDRON
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 1600 W GRAND RIVER AVE SUITE 4
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City | OKEMOS
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State | MI
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Zip | 48864-2394
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Country | US
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Telephone | 517-381-6880
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Fax | 517-638-1688
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Provider Business Mailing Address
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Address Line | PO BOX 13008
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City | LANSING
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State | MI
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Zip | 48901-3008
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Country | US
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Telephone | 517-364-6253
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Fax | 517-364-6204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101015858
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License Number State | MI
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