Provider Demographics
NPI:1437241254
Name:RACICH, KATHLEEN ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:RACICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 48095
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0118
Mailing Address - Country:US
Mailing Address - Phone:813-910-0919
Mailing Address - Fax:813-910-8099
Practice Address - Street 1:2237 TWELVE OAKS WAY
Practice Address - Street 2:#104
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6983
Practice Address - Country:US
Practice Address - Phone:813-910-0919
Practice Address - Fax:813-910-8099
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0574012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0546AMedicare ID - Type Unspecified
G50931Medicare UPIN