Provider Demographics
NPI:1679849178
Name:SALCICCIOLI, KATHERINE BOHARD (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BOHARD
Last Name:SALCICCIOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:BOHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 E MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5000
Mailing Address - Country:US
Mailing Address - Phone:734-764-5176
Mailing Address - Fax:734-936-9470
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:2381 CARDIOVASCULAR CENTER
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-764-5176
Practice Address - Fax:734-936-9470
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10042711207R00000X, 208000000X
MI4301117203207R00000X
TXQ63692080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics