Provider Demographics
NPI:1144394461
Name:LONERGAN, KATY LEASE II (MD)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:LEASE
Last Name:LONERGAN
Suffix:II
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:ELIZABETH
Other - Last Name:LEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-8000
Mailing Address - Fax:214-645-7269
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-8000
Practice Address - Fax:214-645-7269
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86361208M00000X, 207RC0000X
TXP4341207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A863610Medicare ID - Type Unspecified