Healthcare Provider Details

I. General information

NPI: 1114357191
Provider Name (Legal Business Name): KATELYN URBAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 AUBURN RD STE 301
CONCORD TOWNSHIP OH
44077-9618
US

IV. Provider business mailing address

2000 AUBURN DR STE 350
BEACHWOOD OH
44122-4327
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-7546
  • Fax: 440-352-5260
Mailing address:
  • Phone: 440-646-1600
  • Fax: 440-646-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number20A21877
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34.017995
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number20A21877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: