Provider Demographics
NPI:1851645360
Name:KATOOT, AHMED M
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:M
Last Name:KATOOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E. 23RD STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4556
Mailing Address - Country:US
Mailing Address - Phone:850-913-1500
Mailing Address - Fax:850-913-1584
Practice Address - Street 1:217 E. 23RD STREET
Practice Address - Street 2:SUITE E
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4556
Practice Address - Country:US
Practice Address - Phone:850-913-1500
Practice Address - Fax:850-913-1584
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991736251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
107791Medicare Oscar/Certification