Provider Demographics
NPI:1710507678
Name:MCDONALD, KATHRYN RYAN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RYAN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3616
Mailing Address - Country:US
Mailing Address - Phone:248-865-7481
Mailing Address - Fax:
Practice Address - Street 1:7655 WHEELER RD
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9697
Practice Address - Country:US
Practice Address - Phone:734-478-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant