Provider Demographics
NPI:1346612421
Name:KAJO MEDICAL PC
Entity Type:Organization
Organization Name:KAJO MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:DUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-340-1500
Mailing Address - Street 1:2422 DANVILLE RD SW
Mailing Address - Street 2:STE. C
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4220
Mailing Address - Country:US
Mailing Address - Phone:256-340-1500
Mailing Address - Fax:256-340-1566
Practice Address - Street 1:2422 DANVILLE RD SW
Practice Address - Street 2:STE. C
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4220
Practice Address - Country:US
Practice Address - Phone:256-340-1500
Practice Address - Fax:256-340-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20222207Q00000X
AL158213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU61104Medicare UPIN
AL051519618DUPMedicare UPIN