MEDICARE: JOSEPH J KATTA MD, PA

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
1	207RG0100X	Gastroenterology Physician	047323	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	AJ581	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0006W	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1639593858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH J KATTA MD, PA

Provider Business Mailing Address
First Line	:	1811 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4756
Country	:	US
Telephone Number	:	772-595-5988
Fax Number	:	772-595-5989

Provider Business Practice Location Address
First Line	:	1811 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4756
Country	:	US
Telephone Number	:	772-595-5988
Fax Number	:	772-595-5989

Authorized Official
Title or Position	:	CHIEF OFFICER
Name	:	JOSEPH J KATTA
Credential	:	MD
Telephone Number	:	772-595-5988

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	02/07/2014

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