Provider Demographics
NPI:1316169287
Name:HANSUL, KATHERINE KELLY (DO)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:KELLY
Last Name:HANSUL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:2221 HEALTH DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9700
Practice Address - Country:US
Practice Address - Phone:616-532-5025
Practice Address - Fax:616-301-1915
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-12-01
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Provider Licenses
StateLicense IDTaxonomies
MI5101015657207VH0002X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine