Individual
DR. KATHRYN L PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 E DAY RD, MISHAWAKA, IN 46545-3455
(574) 237-9340
(574) 239-1474
Mailing address
301 E DAY RD, MISHAWAKA, IN 46545-3455
(574) 237-9340
(574) 239-1474
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
01055115A
IN
208VP0000X
Pain Medicine Physician
Primary
01055115A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200349420
—
IN
Enumeration date
10/25/2005
Last updated
11/04/2019
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