Provider Demographics
NPI:1427228063
Name:KATHLEEN E KAUTZ M D MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KATHLEEN E KAUTZ M D MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-352-7768
Mailing Address - Street 1:1029 KEYSER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6215
Mailing Address - Country:US
Mailing Address - Phone:318-352-7768
Mailing Address - Fax:318-357-3661
Practice Address - Street 1:1029 KEYSER AVE STE A
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6215
Practice Address - Country:US
Practice Address - Phone:318-352-7768
Practice Address - Fax:318-357-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15485R207R00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471704Medicaid
LAH34190Medicare UPIN
LA1471704Medicaid