MEDICARE: KERRI ANNE KATONA PA-C

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	363A00000X	Physician Assistant	5601005615	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OF96004	OTHER	MI	MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1689908550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI ANNE KATONA PA-C

Provider Business Mailing Address
First Line	:	850 N OTSEGO AVE
Second Line	:	SUITE 1
City	:	GAYLORD
State	:	MI
Zip	:	49735-1568
Country	:	US
Telephone Number	:	989-731-7708
Fax Number	:	989-731-7929

Provider Business Practice Location Address
First Line	:	3696 S STRAITS HWY
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-5136
Country	:	US
Telephone Number	:	231-238-0581
Fax Number	:	231-238-0586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	01/30/2015

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Directions to “ KERRI ANNE KATONA PA-C” Practice Location

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