Provider Demographics
NPI:1457388423
Name:HAYWARD, KATHERINE SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-0458
Mailing Address - Country:US
Mailing Address - Phone:269-471-7741
Mailing Address - Fax:269-471-1581
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-471-7741
Practice Address - Fax:269-471-1581
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8823059OtherCIGNA
MI270381199OtherGROUP TAX ID
MI0801101312OtherBLUE CROSS
MI1457388423Medicaid
MI080088958OtherRAILROAD MEDICARE
MI1538397120OtherGROUP NPI
MI01-31473OtherPHP
MI01-31473OtherPHP
MI0801101312OtherBLUE CROSS
MI8823059OtherCIGNA