Provider Demographics
NPI:1871644708
Name:KATTLER, HOWARD J (DPM)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
Last Name:KATTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4153
Mailing Address - Country:US
Mailing Address - Phone:302-475-5285
Mailing Address - Fax:302-475-5285
Practice Address - Street 1:2217 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4153
Practice Address - Country:US
Practice Address - Phone:302-475-5285
Practice Address - Fax:302-475-5285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000060213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000025017Medicaid
DE0000025017Medicaid
DE470839T04Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID
DE555004Medicare ID - Type UnspecifiedGROUP#