Provider Demographics
NPI:1164072203
Name:KATIC, CHRISTIAN VID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:VID
Last Name:KATIC
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2102
Mailing Address - Country:US
Mailing Address - Phone:919-471-8653
Mailing Address - Fax:919-471-8653
Practice Address - Street 1:3116 N DUKE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2102
Practice Address - Country:US
Practice Address - Phone:919-471-8653
Practice Address - Fax:919-471-8653
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09334207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine