Provider Demographics
NPI:1225060494
Name:HEBERT, KATHY (MD, MMM, MPH)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:HEBERT
Suffix:
Gender:F
Credentials:MD, MMM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 COLLINS AVE APT 17D
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2269
Mailing Address - Country:US
Mailing Address - Phone:305-243-4664
Mailing Address - Fax:305-243-9927
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:JACKSON MEMORIAL HOSPITAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-5544
Practice Address - Fax:305-585-6490
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019062207R00000X
FLME0099727207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA110155429OtherRAILROAD MEDICARE
FLAG803ZOtherMEDICARE
LA1936073Medicaid
LA110155429OtherRAILROAD MEDICARE
LA5R253Medicare ID - Type Unspecified