Provider Demographics
NPI:1023006178
Name:KATALINICH, GERY BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERY
Middle Name:BRIAN
Last Name:KATALINICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 HWY 17 BYP S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4503
Mailing Address - Country:US
Mailing Address - Phone:843-293-6366
Mailing Address - Fax:843-293-4469
Practice Address - Street 1:5046 HWY 17 BYP S
Practice Address - Street 2:SUITE 102
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4503
Practice Address - Country:US
Practice Address - Phone:843-293-6366
Practice Address - Fax:843-293-4469
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD0902Medicaid
SCQ233690281Medicare ID - Type Unspecified
SCU19920Medicare UPIN