Park, Kathryn L

Park, Kathryn L is an individual health care provider with primary practice located at 301 E Day Rd , Mishawaka IN 46545-3455. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is her primary health care specialty. Park, Kathryn L can be contacted via phone (574) 237-9340.

Contact Information

Primary practice address
301 E Day Rd Mishawaka IN 46545-3455
Phone: (574) 237-9340
Fax: (574) 239-1474
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 01055115A Indiana
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X 01055115A Indiana

Profile Details

NPI number 1548250186
LBN Legal business name Park, Kathryn L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2005
Last updated Nov 4th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548250186 NPPES
Indiana MEDICAID 200349420

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