Provider Demographics
NPI:1417005968
Name:MOK, CATHLEEN ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:ELLEN
Last Name:MOK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CATHLEEN
Other - Middle Name:ELLEN
Other - Last Name:CROWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1201 S MAIN ST
Mailing Address - Street 2:DEPT FPN
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8481
Mailing Address - Country:US
Mailing Address - Phone:219-681-6995
Mailing Address - Fax:219-757-6481
Practice Address - Street 1:11161 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8564
Practice Address - Country:US
Practice Address - Phone:219-662-9424
Practice Address - Fax:219-662-7465
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003141A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine