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NPI Code Detail

MEDICARE: DR. LEONID M. KATKOVSKY M.D.

MEDICARE: DR. LEONID M. KATKOVSKY 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
1171000000XMilitary Health Care Provider77555OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
177555OTHEROHMEDICAL LICENSE

General Provider Information

NPI Number : 1821087719
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEONID M. KATKOVSKY M.D.
Provider Business Mailing Address
First Line : 15301 WARREN SHINGLE RD
Second Line : 9TH MDG
City : BEALE AFB
State : CA
Zip : 95903-1907
Country : US
Telephone Number : 530-634-4730
Fax Number :
Provider Business Practice Location Address
First Line : 15301 WARREN SHINGLE RD
Second Line : 9TH MDG
City : BEALE AFB
State : CA
Zip : 95903-1907
Country : US
Telephone Number : 530-634-4730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 02/25/2008

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