Provider Demographics
NPI:1316384555
Name:OSTEDGAARD, KATHARINE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:LOUISE
Last Name:OSTEDGAARD
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 1:2521 STOCKTON BLVD STE 7200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2207
Mailing Address - Country:US
Mailing Address - Phone:541-968-2306
Mailing Address - Fax:
Practice Address - Street 1:2521 STOCKTON BLVD STE 7200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:541-968-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154794207Y00000X
IAR-9697207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology