Individual
KATHLEEN A MAMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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
Update your record
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