Provider Demographics
NPI:1356335814
Name:MAKAREWICZ, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MAKAREWICZ
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 1:2219 W OLIVE AVE
Mailing Address - Street 2:#219
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2625
Mailing Address - Country:US
Mailing Address - Phone:818-847-6022
Mailing Address - Fax:818-847-6029
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-847-6022
Practice Address - Fax:818-847-6029
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66925207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A669250Medicaid
CAWA66925BMedicare PIN
CAWA66925CMedicare PIN
CAHA66925BMedicare PIN
CAHA66925DMedicare PIN
CA00A669250Medicaid
CAWA66925AMedicare PIN
CAWA66925DMedicare PIN