Provider Demographics
NPI:1518202803
Name:DOBBS, KATHLEEN JILL (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JILL
Last Name:DOBBS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JILL
Other - Last Name:WHITEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2653
Mailing Address - Country:US
Mailing Address - Phone:248-398-6459
Mailing Address - Fax:248-398-4770
Practice Address - Street 1:221 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2653
Practice Address - Country:US
Practice Address - Phone:248-398-6459
Practice Address - Fax:248-398-4770
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant