Individual
KATIE R KWAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
44428 WOODWARD AVE STE 102, PONTIAC, MI 48341-5009
(248) 858-3126
(248) 858-6499
Mailing address
44428 WOODWARD AVE STE 102, PONTIAC, MI 48341-5009
(248) 858-3126
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301111118
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01685274
AMERIGROUP
—
01
—
706079
WELLCARE
—
Enumeration date
05/08/2009
Last updated
11/07/2025
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