Provider Demographics
NPI:1700824653
Name:FLANNAGAN, KATHLEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:FLANNAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:SCHWIERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 ST. CHARLES STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546
Mailing Address - Country:US
Mailing Address - Phone:812-634-6600
Mailing Address - Fax:812-634-6621
Practice Address - Street 1:2005 ST. CHARLES STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546
Practice Address - Country:US
Practice Address - Phone:812-634-6600
Practice Address - Fax:812-634-6621
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085231207W00000X
IN01063124A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633127Medicaid
IN200520030Medicaid
KY64110737Medicaid
000000363168OtherBCBS
31.1473421OtherTAX ID
I32385Medicare UPIN
OHFL4161282Medicare ID - Type Unspecified
IN252130BMedicare PIN
OHFL4161283Medicare ID - Type Unspecified
OH2633127Medicaid
KY64110737Medicaid