Provider Demographics
NPI:1356337976
Name:SEITZ, KATRINA ANN (MD)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:ANN
Last Name:SEITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ANN
Other - Last Name:ROCH-SEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5701 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2640
Mailing Address - Country:US
Mailing Address - Phone:317-253-6364
Mailing Address - Fax:
Practice Address - Street 1:8051 S EMERSON AVE
Practice Address - Street 2:STE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8600
Practice Address - Country:US
Practice Address - Phone:317-865-3600
Practice Address - Fax:317-885-3850
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032842A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN036780AMedicare ID - Type Unspecified
IND94375Medicare UPIN