Provider Demographics
NPI:1881680361
Name:KATULA, GARRETT (DO)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:KATULA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W VETERANS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4728
Mailing Address - Country:US
Mailing Address - Phone:630-236-4270
Mailing Address - Fax:630-236-4271
Practice Address - Street 1:1100 VETERANS PKWY.
Practice Address - Street 2:SUITE 200
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1095
Practice Address - Country:US
Practice Address - Phone:630-236-4270
Practice Address - Fax:630-236-4271
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G46257Medicare UPIN