Provider Demographics
NPI:1780666925
Name:BRITTAN, KATHY J (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:BRITTAN
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 1:601 JOHN ST # 42
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:451 HEALTH PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-8242
Practice Address - Country:US
Practice Address - Phone:269-655-3065
Practice Address - Fax:269-655-0585
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238601OtherMEDICARE RURAL HEALTH CLINIC NUMBER
MICA4396OtherRAILROAD MEDICARE
MI4938435Medicaid
MI4938435Medicaid
E05823Medicare UPIN