Individual
KATHLEEN A MAMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DRIVE, 8TH FLOOR CS MOTT CHILDRENS HOSPITAL, ANN ARBOR, MI 48109-4259
(734) 936-4185
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301064675
MI
2080A0000X
Pediatric Adolescent Medicine Physician
4301064675
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3176714
—
MI
01
—
350F361320
BCBSM
MI
Enumeration date
03/23/2006
Last updated
05/12/2014
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