Provider Demographics
NPI:1164786570
Name:CUELLO LA O, KATHERINE FOLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:FOLEY
Last Name:CUELLO LA O
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:21510 HARRINGTON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2378
Mailing Address - Country:US
Mailing Address - Phone:586-228-3800
Mailing Address - Fax:586-228-9800
Practice Address - Street 1:21510 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2377
Practice Address - Country:US
Practice Address - Phone:586-228-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315204340208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty