Healthcare Provider Details

I. General information

NPI: 1205586542
Provider Name (Legal Business Name): FATOU KA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST (PATHOLOGY DEPARTMENT)
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-7284
  • Fax: 513-584-3892
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number82269
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: