Individual
KATHRYN MARIE DOMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1170 FORTUNE BLVD, SHILOH, IL 62269-7358
(618) 997-5266
(618) 997-5285
Mailing address
1000 OAKLAND DR, KALAMAZOO, MI 49008-1282
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036161559
IL
390200000X
Student in an Organized Health Care Education/Training Program
5151011654
MI
Other
Enumeration date
05/21/2018
Last updated
03/02/2023
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