Healthcare Provider Details

I. General information

NPI: 1831862325
Provider Name (Legal Business Name): KATUREEBE MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BLUE SPRUCE TRL
LILBURN GA
30047-7060
US

IV. Provider business mailing address

290 BLUE SPRUCE TRL
LILBURN GA
30047-7060
US

V. Phone/Fax

Practice location:
  • Phone: 617-901-6120
  • Fax:
Mailing address:
  • Phone: 617-901-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN BANEGURA
Title or Position: OWNER
Credential: MD
Phone: 617-901-6120