Provider Demographics
NPI:1013147529
Name:MICHENER, KATHERINE HELEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HELEN
Last Name:MICHENER
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 1:23 WARREN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 WARREN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7906
Practice Address - Country:US
Practice Address - Phone:781-933-0710
Practice Address - Fax:781-937-3947
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250771207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology