Individual
KATHLEEN M CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6910 S CEDAR ST, LANSING, MI 48911-6912
(517) 694-4134
(517) 694-1629
Mailing address
6910 S CEDAR ST, LANSING, MI 48911-6912
(517) 694-4134
(517) 694-1629
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
KC046039
MI
208D00000X
General Practice Physician
Primary
KC046039
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001492
MCLAREN
MI
01
—
700C361780
BCBS
MI
01
—
KC046039
LICENSE NUMBER
MI
Enumeration date
01/31/2007
Last updated
01/21/2011
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