Provider Demographics
NPI:1003303470
Name:KATEREGGA, ALICE (MD)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:KATEREGGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ALICE
Other - Middle Name:MARY NANTABA
Other - Last Name:KATEREGGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3290 NW 9TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3332
Mailing Address - Country:US
Mailing Address - Phone:786-747-7233
Mailing Address - Fax:305-585-6043
Practice Address - Street 1:1611 NW 12TH AVENUE JACKSON MEMORIAL HOSPITAL,
Practice Address - Street 2:SURGICAL TRAINING OFFICE - HOLTZ BUILDING, ET 2169
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-1280
Practice Address - Fax:305-585-6043
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2019-04-10
Deactivation Date:2018-11-28
Deactivation Code:
Reactivation Date:2019-04-10
Provider Licenses
StateLicense IDTaxonomies
FL27733390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program