Healthcare Provider Details

I. General information

NPI: 1346612421
Provider Name (Legal Business Name): KAJO MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 HIGHWAY 31 S STE 116
DECATUR AL
35603-1538
US

IV. Provider business mailing address

2828 HIGHWAY 31 S STE 116
DECATUR AL
35603-1538
US

V. Phone/Fax

Practice location:
  • Phone: 256-340-1500
  • Fax: 256-340-1566
Mailing address:
  • Phone: 256-340-1500
  • Fax: 256-340-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20222
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number158
License Number StateAL

VIII. Authorized Official

Name: DR. KATHLEEN MARGARET DUPPER
Title or Position: PRESIDENT
Credential: MD
Phone: 256-340-1500