Provider Demographics
NPI:1477292514
Name:OLIVARES, KATHERINE LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LEIGH
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VAN DYKE ST APT 404
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2491
Mailing Address - Country:US
Mailing Address - Phone:317-442-8442
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:317-577-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program