Provider Demographics
NPI:1841432705
Name:AGNELLO, KATIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:R
Last Name:AGNELLO
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 1:825 VENETIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7163
Mailing Address - Country:US
Mailing Address - Phone:941-483-5730
Mailing Address - Fax:
Practice Address - Street 1:825 VENETIAN PKWY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7163
Practice Address - Country:US
Practice Address - Phone:941-483-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121751207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology