=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639134570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNE MICHELLE KAKATY-MONZO DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2006
-----------------------------------------------------
Last Update Date | 04/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 RITTENHOUSE PL
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19003-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-420-1615
-----------------------------------------------------
Fax | 610-642-1607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2250 OLD SENTINEL TRL
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19355-7500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-420-1615
-----------------------------------------------------
Fax | 610-642-1607
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | OS012324
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------