Provider Demographics
NPI:1649448341
Name:GAMBOSOVA, KATARINA (MD)
Entity type:Individual
Prefix:DR
First Name:KATARINA
Middle Name:
Last Name:GAMBOSOVA
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 1:346 MAINE ST STE 160
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1393
Mailing Address - Country:US
Mailing Address - Phone:785-217-4827
Mailing Address - Fax:877-477-1312
Practice Address - Street 1:346 MAINE ST STE 160
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1393
Practice Address - Country:US
Practice Address - Phone:785-217-4827
Practice Address - Fax:877-477-1312
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1489922080P0205X
KS04-341-812080P0205X
KS04-34181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2129007OtherMECIARE PTAN
KSKA2129007OtherMECIARE PTAN