Provider Demographics
NPI:1295781649
Name:FLORIO, KATHRYN I (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:I
Last Name:FLORIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:I
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-8130
Mailing Address - Fax:605-328-8101
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 201
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0414
Practice Address - Country:US
Practice Address - Phone:605-328-8188
Practice Address - Fax:605-328-8101
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD47012084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS8272Medicare PIN
SD130024221Medicare PIN
D71473Medicare UPIN