Provider Demographics
NPI:1164484762
Name:MICHAELS-BOGDAN, KATERINA M (MD)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:M
Last Name:MICHAELS-BOGDAN
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 1:2600 TAMARACK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-5560
Mailing Address - Country:US
Mailing Address - Phone:860-646-1157
Mailing Address - Fax:860-646-9877
Practice Address - Street 1:2600 TAMARACK AVE STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5560
Practice Address - Country:US
Practice Address - Phone:860-646-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042485207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001424853Medicaid