MEDICARE: KATHERINE LYNN FONTICHIARO M.D.

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	207N00000X	Dermatology Physician	4301105378	MI

General Provider Information

NPI Number	:	1134546021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LYNN FONTICHIARO M.D.

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR LBBY J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 N MAIN ST STE 600
Second Line	:
City	:	CHELSEA
State	:	MI
Zip	:	48118-1703
Country	:	US
Telephone Number	:	734-385-7255
Fax Number	:

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

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	09/21/2025

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