Provider Demographics
NPI:1306832563
Name:DESSAUER, KATI ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KATI
Middle Name:ELIZABETH
Last Name:DESSAUER
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 1:100 RIDGE VIEW DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5589
Mailing Address - Country:US
Mailing Address - Phone:919-859-7044
Mailing Address - Fax:919-859-7052
Practice Address - Street 1:100 RIDGE VIEW DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5589
Practice Address - Country:US
Practice Address - Phone:919-859-7044
Practice Address - Fax:919-859-7052
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2009-02-02
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
NC32201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1092658OtherCIGNA
NCC0514OtherMEDCOST
NC25129OtherWELLPATH
NC1409466OtherUNITED HEALTHCARE
NC4352699OtherAETNA
NC58364OtherBCBS
NCE75391Medicare UPIN
NC4352699OtherAETNA