Provider Demographics
NPI:1003224932
Name:KATADA, MARCO
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:KATADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-0531
Mailing Address - Country:US
Mailing Address - Phone:620-275-0644
Mailing Address - Fax:620-272-0239
Practice Address - Street 1:1111 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5958
Practice Address - Country:US
Practice Address - Phone:620-275-0644
Practice Address - Fax:620-272-0239
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76331363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health