Provider Demographics
NPI:1134330244
Name:PERKINS, KATHLEEN MARY (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:PERKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:809 W DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-8961
Mailing Address - Country:US
Mailing Address - Phone:810-678-4000
Mailing Address - Fax:810-678-4077
Practice Address - Street 1:809 W DRYDEN RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8961
Practice Address - Country:US
Practice Address - Phone:810-678-4000
Practice Address - Fax:810-678-4077
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101016777OtherPHYSICIAN LICENSE
MI5315026333OtherCONTROLLED SUBSTANCE LIC
MIFB0479039OtherUNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION