1811994999 NPI number — MICHAEL J. KATIN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811994999 NPI number — MICHAEL J. KATIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATIN
Provider First Name:
MICHAEL
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811994999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 947395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30394-7395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-356-1701
Provider Business Mailing Address Fax Number:
401-356-4537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 CASS AVE UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-356-1701
Provider Business Practice Location Address Fax Number:
401-356-4537
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  ME0026427 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: MD11285 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0001X , with the licence number: G26661 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 4877 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 2001-01567 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0203X , with the licence number: ME26427 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 127667-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4129712 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 592485899 . This is a "METCARE VENDOR ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00787 . This is a "UNV. HLTHCR. PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01738807 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205786 . This is a "AVMED PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: MB505 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: MB506 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 24-05164 . This is a "UTD. HLTHCR. PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0916153-016 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: MD11285 . This is a "LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 00G26610 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 065594500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76715 . This is a "OP. ENG. LOC. 825 PROV. #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 985684 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2019966 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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