Provider Demographics
NPI:1134241219
Name:EATON ORTHOPAEDICS LLC
Entity type:Organization
Organization Name:EATON ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATULLE
Authorized Official - Middle Name:KOLI
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-573-5626
Mailing Address - Street 1:900 CARILLON PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1115
Mailing Address - Country:US
Mailing Address - Phone:727-573-5626
Mailing Address - Fax:727-573-5627
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1115
Practice Address - Country:US
Practice Address - Phone:727-573-5626
Practice Address - Fax:727-573-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23221XMedicare ID - Type Unspecified