Provider Demographics
NPI:1316396385
Name:OMERNICK, KATHERINE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:OMERNICK
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:UW HOSPITALS & CLINICS
Mailing Address - Street 2:600 HIGHLAND AVE
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-0001
Mailing Address - Country:US
Mailing Address - Phone:414-534-5464
Mailing Address - Fax:
Practice Address - Street 1:4010 AERIAL WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9757
Practice Address - Country:US
Practice Address - Phone:541-242-8500
Practice Address - Fax:541-242-8502
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1316396385208000000X
ORMD194500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics