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General NPI Number Information
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NPI Number | 1588818496
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Entity Type | Individual
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Provider Name | KATHERINE MARIE MCCARTHY PA
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Gender | Female
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD DEPARTMENT OF NEONATOLOGY
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 248-849-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 3948 SAGINAW TRL
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City | WATERFORD
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State | MI
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Zip | 48329-4247
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Country | US
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Telephone | 248-673-1440
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | KL239097
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 4704239097
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License Number State | MI
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