Provider Demographics
NPI:1801686803
Name:GOLEM, KATIELYNN
Entity type:Individual
Prefix:
First Name:KATIELYNN
Middle Name:
Last Name:GOLEM
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 1:211 LASSEIGNE ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1093
Mailing Address - Country:US
Mailing Address - Phone:989-992-4139
Mailing Address - Fax:
Practice Address - Street 1:211 LASSEIGNE ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1093
Practice Address - Country:US
Practice Address - Phone:989-992-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI$$$$$$$$$208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty