Provider Demographics
NPI:1134215270
Name:IGNACIO, KATHERINE MAE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MAE
Last Name:IGNACIO
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-339-3551
Mailing Address - Fax:
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2633
Practice Address - Country:US
Practice Address - Phone:319-339-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059242207R00000X, 208M00000X
TXP4318207R00000X
OH35088512208M00000X
IAMD-46962207R00000X, 208M00000X
UT10511726-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG59242Medicaid
GA01059317OtherAMERIGROUP
GA278857547AMedicaid
GA278857547BMedicaid
GA404271OtherWELLCARE
GAP00803300OtherRR MEDICARE
OH2693330Medicaid
GAP00394178OtherRR MEDICARE
SCG59242Medicaid
GA01059317OtherAMERIGROUP
GA202I116873Medicare PIN
GA278857547BMedicaid