Healthcare Provider Details

I. General information

NPI: 1518230499
Provider Name (Legal Business Name): KATI L MCLEOD P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15022 N 20TH PL
PHOENIX AZ
85022-4049
US

IV. Provider business mailing address

2650 WARRENVILLE RD SUITE 280
DOWNERS GROVE IL
60515-1748
US

V. Phone/Fax

Practice location:
  • Phone: 928-853-7227
  • Fax:
Mailing address:
  • Phone: 630-324-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5060
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3353
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085005565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: