Provider Demographics
NPI:1235391251
Name:HEAL, KATHRYN JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JEAN
Last Name:HEAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39650 ORCHARD HILL PL STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5391
Mailing Address - Country:US
Mailing Address - Phone:248-449-7010
Mailing Address - Fax:248-449-7015
Practice Address - Street 1:39650 ORCHARD HILL PL STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5391
Practice Address - Country:US
Practice Address - Phone:248-449-7010
Practice Address - Fax:248-449-7015
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2019-09-25
Deactivation Date:2019-08-26
Deactivation Code:
Reactivation Date:2019-09-05
Provider Licenses
StateLicense IDTaxonomies
MI5101017693207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine