Provider Demographics
NPI:1063594075
Name:GRANT, KATHLEEN MARY (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4101 WOOLWORTH AVE
Mailing Address - Street 2:11TH FLOOR SUDP
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1850
Mailing Address - Country:US
Mailing Address - Phone:402-449-0679
Mailing Address - Fax:402-977-5684
Practice Address - Street 1:4101 WOOLWORTH AVE
Practice Address - Street 2:11TH FLOOR SUDP
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1850
Practice Address - Country:US
Practice Address - Phone:402-449-0679
Practice Address - Fax:402-977-5684
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE18660207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine