Provider Demographics
NPI:1952519365
Name:HANLON-LUNDBERG, KATHLEEN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:HANLON-LUNDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E STADIUM BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4823
Mailing Address - Country:US
Mailing Address - Phone:734-477-5100
Mailing Address - Fax:734-477-5111
Practice Address - Street 1:2340 E STADIUM BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4823
Practice Address - Country:US
Practice Address - Phone:734-477-5100
Practice Address - Fax:734-477-5111
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075444207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4166445Medicaid
MIE90485Medicare UPIN
MI0H16063106Medicare ID - Type Unspecified