Provider Demographics
NPI:1669573028
Name:WASYLIK, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:WASYLIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 76479
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33734
Mailing Address - Country:US
Mailing Address - Phone:727-329-5400
Mailing Address - Fax:727-329-5402
Practice Address - Street 1:601 5TH ST. SOUTH
Practice Address - Street 2:#701
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-329-5400
Practice Address - Fax:727-329-5402
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN48414207YP0228X
FLME98034207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN787267400Medicaid