Provider Demographics
NPI:1467422832
Name:LUM, KATHARINE S (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:S
Last Name:LUM
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 1:777 37TH ST STE C101
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7301
Mailing Address - Country:US
Mailing Address - Phone:772-562-6566
Mailing Address - Fax:772-562-6570
Practice Address - Street 1:777 37TH ST STE C101
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7301
Practice Address - Country:US
Practice Address - Phone:772-562-6566
Practice Address - Fax:772-562-6570
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME004400207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62534OtherBLUE CROSS BLUE SHEILD
FL10D0952099OtherCLIA NUMBER
FL160040633OtherRAILROAD MEDICARE
FLK0449OtherMEDICARE GROUP NUMBER
FL62534OtherBLUE CROSS BLUE SHEILD
FL62534OtherBLUE CROSS BLUE SHEILD
FLD57488Medicare UPIN