Provider Demographics
NPI:1790216919
Name:SNOW, KATELIN A (MD)
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:A
Last Name:SNOW
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 1:5555 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2513
Mailing Address - Country:US
Mailing Address - Phone:305-284-3333
Mailing Address - Fax:305-284-5054
Practice Address - Street 1:5555 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2513
Practice Address - Country:US
Practice Address - Phone:305-284-3333
Practice Address - Fax:305-284-5054
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL144398207R00000X
390200000X
FLME144398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program