Individual
KATHRYN L HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
249293
MA
2085R0202X
Diagnostic Radiology Physician
Primary
4301106496
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2008
Last updated
04/30/2015
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