Provider Demographics
NPI:1659614394
Name:DE SOUZA, KATHERINE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARY
Last Name:DE SOUZA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-5470
Mailing Address - Fax:314-362-3335
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV OBGYN MIS GYN, STE 710
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-747-5470
Practice Address - Fax:314-362-3335
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2024-04-25
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Provider Licenses
StateLicense IDTaxonomies
MO2021032190207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200100815Medicaid