Provider Demographics
NPI:1073801874
Name:KATTIKAT, SOUMYA (MD)
Entity Type:Individual
Prefix:
First Name:SOUMYA
Middle Name:
Last Name:KATTIKAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N KEENE ST
Mailing Address - Street 2:SOUTH PAVILION BUILDING SUITE 118
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-882-8216
Mailing Address - Fax:573-884-8823
Practice Address - Street 1:404 N KEENE ST
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-882-8216
Practice Address - Fax:573-884-8823
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT199388208000000X
FLME 1184962080P0205X
MO20160413472080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics