Provider Demographics
NPI:1225224025
Name:TAKUNDWA, KATHERINE MAKAITA (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MAKAITA
Last Name:TAKUNDWA
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:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-341-2909
Mailing Address - Fax:256-341-2552
Practice Address - Street 1:1201 7TH STREET, SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4023
Practice Address - Country:US
Practice Address - Phone:256-341-2909
Practice Address - Fax:256-341-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29101207R00000X
TXN4776208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist