Provider Demographics
NPI:1164627204
Name:BURNS, KATHERINE SUE (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUE
Last Name:BURNS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:SUE
Other - Last Name:LEINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2400
Mailing Address - Fax:515-241-2401
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2400
Practice Address - Fax:515-241-2401
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8132207R00000X
IA03933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1164627204Medicaid
IA719260193Medicare PIN