Provider Demographics
NPI:1508248576
Name:SCHIAVO, KAITLIN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:SCHIAVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ANN
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:204 N KEENE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8136
Mailing Address - Country:US
Mailing Address - Phone:573-442-0320
Mailing Address - Fax:
Practice Address - Street 1:204 N KEENE ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8136
Practice Address - Country:US
Practice Address - Phone:573-442-2961
Practice Address - Fax:573-442-0421
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019010175207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty