Provider Demographics
NPI:1497741052
Name:CHAMBERLAIN, KATHERINE ANN (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:POMAVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-723-6791
Mailing Address - Fax:989-725-5061
Practice Address - Street 1:1555 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9775
Practice Address - Country:US
Practice Address - Phone:989-723-6791
Practice Address - Fax:989-725-5061
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010544382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G86005OtherBCBS
MI2607800342OtherHEALTHPLUS
MIKC054438OtherBCBS
F55450Medicare UPIN