MEDICARE: KATHERINE ANN JAWOR 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	2084P0800X	Psychiatry Physician	5101012270	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	383621541	OTHER	MI	ASR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2656100914	OTHER	MI	BCBS MI
4	102239	OTHER	MI	VALUE OPTIONS
5	214510000	OTHER	MI	MAGELLAN

General Provider Information

NPI Number	:	1336188556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANN JAWOR D.O.

Provider Business Mailing Address
First Line	:	300 68TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49548-6927
Country	:	US
Telephone Number	:	616-455-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	17325 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9702
Country	:	US
Telephone Number	:	616-364-1500
Fax Number	:	616-364-6400

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	06/17/2013

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