Provider Demographics
NPI:1326474172
Name:TOEPKE, KATHLEEN P (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:TOEPKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 CAMPUS RIDGE DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6125
Mailing Address - Country:US
Mailing Address - Phone:989-837-9200
Mailing Address - Fax:989-837-9205
Practice Address - Street 1:4401 CAMPUS RIDGE DR STE 1100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6125
Practice Address - Country:US
Practice Address - Phone:989-837-9200
Practice Address - Fax:989-837-9205
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant