Provider Demographics
NPI:1407935588
Name:PARMELEE-PETERS, KATRINA LYN (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYN
Last Name:PARMELEE-PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:LYN
Other - Last Name:PARMELEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 270
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-853-2223
Mailing Address - Fax:248-853-4300
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:STE 150
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-853-6300
Practice Address - Fax:248-853-6303
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075885207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F32365OtherBCBS
MI0F32365OtherBCBS