Provider Demographics
NPI:1568797678
Name:KATHERINE M WALDEN, M.D.
Entity Type:Organization
Organization Name:KATHERINE M WALDEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-353-3503
Mailing Address - Street 1:5320 HOLIDAY TER STE 3
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2100
Mailing Address - Country:US
Mailing Address - Phone:269-353-3503
Mailing Address - Fax:
Practice Address - Street 1:5320 HOLIDAY TER STE 3
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2100
Practice Address - Country:US
Practice Address - Phone:269-353-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010713702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty