Provider Demographics
NPI:1588619118
Name:KERSTEN, CATALINA M (MD)
Entity Type:Individual
Prefix:
First Name:CATALINA
Middle Name:M
Last Name:KERSTEN
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:404 KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6626
Practice Address - Country:US
Practice Address - Phone:573-882-6544
Practice Address - Fax:573-884-5226
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166676208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1200376OtherUNITED HEALHCARE
MO370017726OtherRR MEDICARE
MO442471OtherHEALTHLLINK
MO130707OtherBLUE SHIELD/BLUE CHOICE
MO205177207Medicaid
KS2087152501OtherKANSAS MEDICAID
MO966885236Medicare PIN
MO893010635Medicare PIN
MO205177207Medicaid