MEDICARE: DR. KATHERINE M. WALDEN MD

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	4301071370	MI

General Provider Information

NPI Number	:	1912961814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE M. WALDEN MD

Provider Business Mailing Address
First Line	:	4029 W MAIN ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	269-381-9511
Fax Number	:	269-381-9512

Provider Business Practice Location Address
First Line	:	4029 W MAIN ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	269-381-9511
Fax Number	:	269-381-9512

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/21/2022

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