Provider Demographics
NPI:1689709099
Name:AMEGATCHER, KATTIE YNEZ (MD)
Entity Type:Individual
Prefix:
First Name:KATTIE
Middle Name:YNEZ
Last Name:AMEGATCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATTIE
Other - Middle Name:YNEZ
Other - Last Name:MERANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1250 W NATIONAL RD
Mailing Address - Street 2:STE 400
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45315-9506
Mailing Address - Country:US
Mailing Address - Phone:937-832-0006
Mailing Address - Fax:937-832-0017
Practice Address - Street 1:1250 W NATIONAL RD STE 400
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45315-9506
Practice Address - Country:US
Practice Address - Phone:937-836-6000
Practice Address - Fax:937-832-4805
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2929773Medicaid
OHME4258942Medicare PIN
OH2929773Medicaid
OH9931742Medicare PIN