Provider Demographics
NPI:1619498599
Name:WHITE, KATHRYN MARYSE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARYSE
Last Name:WHITE
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 1:1414 W FAIR AVE STE 390
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5407
Mailing Address - Country:US
Mailing Address - Phone:906-225-3881
Mailing Address - Fax:
Practice Address - Street 1:1414 W FAIR AVE STE 390
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5407
Practice Address - Country:US
Practice Address - Phone:906-225-3881
Practice Address - Fax:906-225-0994
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301504950207VX0000X
MI4301054950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics