Provider Demographics
NPI:1568448769
Name:BOREMAN, KATHRYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:M
Last Name:BOREMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 SO. MYRTLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-447-6458
Mailing Address - Fax:727-461-5211
Practice Address - Street 1:613 SO. MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-447-6458
Practice Address - Fax:727-461-5211
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH86745Medicare UPIN