MEDICARE: KATHLEEN MARY PERKINS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101016777	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5101016777	OTHER	MI	PHYSICIAN LICENSE
2	5315026333	OTHER	MI	CONTROLLED SUBSTANCE LIC

General Provider Information

NPI Number	:	1134330244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARY PERKINS D.O.

Provider Business Mailing Address
First Line	:	809 W DRYDEN RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8961
Country	:	US
Telephone Number	:	810-678-4000
Fax Number	:	810-678-4077

Provider Business Practice Location Address
First Line	:	809 W DRYDEN RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8961
Country	:	US
Telephone Number	:	810-678-4000
Fax Number	:	810-678-4077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	03/07/2023

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