Provider Demographics
NPI:1831457621
Name:ABTAHI, KATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ABTAHI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 RIVER CENTER CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7549
Mailing Address - Country:US
Mailing Address - Phone:319-730-7300
Mailing Address - Fax:319-730-7397
Practice Address - Street 1:4251 RIVER CENTER CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-730-7300
Practice Address - Fax:319-730-7397
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05093207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADO-05093OtherIOWA MEDICAL LICENSE