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NPI Code Detail

MEDICARE: KATHARINE VAN FOSSEN M.D.

MEDICARE: KATHARINE VAN FOSSEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician42284-20WI
2207V00000XObstetrics & Gynecology PhysicianME175628FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356316483
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHARINE VAN FOSSEN M.D.
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-6097
Fax Number :
Provider Business Practice Location Address
First Line : 9981 S HEALTHPARK DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3618
Country : US
Telephone Number : 239-343-6097
Fax Number : 855-818-4732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 02/18/2026

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