Individual
KAITLIN MICHELLE WOOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 N RITTER AVE STE 120, INDIANAPOLIS, IN 46219-3045
(317) 355-1000
Mailing address
31400 JOHN R RD, APT 204, MADISON HEIGHTS, MI 48071-1900
(231) 838-1055
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01086276A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300052832
—
IN
Enumeration date
05/10/2016
Last updated
08/04/2021
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