Provider Demographics
NPI:1326371816
Name:KASS, KATHRYN E (PA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:KASS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:600 MACINNES DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1144
Mailing Address - Country:US
Mailing Address - Phone:906-483-1860
Mailing Address - Fax:906-372-3230
Practice Address - Street 1:500 CAMPUS DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1040
Practice Address - Fax:906-483-1270
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006284363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2504OtherWISCONSIN STATE LICENSE
MI0C16002138OtherMEDICARE PTAN
MI0C16002OtherMEDICARE GROUP PTAN