Provider Demographics
NPI:1235496951
Name:LOUNSBERRY, KATHARINE D (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:D
Last Name:LOUNSBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:DAWN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 W ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1502
Mailing Address - Country:US
Mailing Address - Phone:734-667-5152
Mailing Address - Fax:734-667-2579
Practice Address - Street 1:30488 MILFORD RD
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165
Practice Address - Country:US
Practice Address - Phone:248-437-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN22160009Medicare UPIN