Provider Demographics
NPI:1467645531
Name:KATSNELSON, THEODORE S (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:S
Last Name:KATSNELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 S OCEAN DR
Mailing Address - Street 2:14A
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7603
Mailing Address - Country:US
Mailing Address - Phone:513-293-6061
Mailing Address - Fax:
Practice Address - Street 1:1865 S OCEAN DR
Practice Address - Street 2:14A
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7603
Practice Address - Country:US
Practice Address - Phone:513-293-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98384207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology