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NPI Code Detail

MEDICARE: KATHLEEN P SOE D.O.

MEDICARE: KATHLEEN P SOE D.O.
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
1174400000XSpecialistOS8204FL
2207N00000XDermatology PhysicianOS8204FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17881565OTHERFLAETNA PPO
2293930OTHERFLAVMED
33491438OTHERFLAETNA HMO
46272360OTHERFLCIGNA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386633394
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN P SOE D.O.
Provider Business Mailing Address
First Line : 4651 VAN DYKE RD
Second Line :
City : LUTZ
State : FL
Zip : 33558-4880
Country : US
Telephone Number : 813-321-1786
Fax Number : 813-321-1787
Provider Business Practice Location Address
First Line : 725 VIRGINIA STREET
Second Line :
City : DUNEDIN
State : FL
Zip : 34698-6615
Country : US
Telephone Number : 727-734-4551
Fax Number : 727-736-8648
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 09/02/2021

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Directions to “ KATHLEEN P SOE D.O.” Practice Location

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