Provider Demographics
NPI:1811950660
Name:EATON, KATULLE KOLI (MD)
Entity type:Individual
Prefix:DR
First Name:KATULLE
Middle Name:KOLI
Last Name:EATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 CARILLON PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1115
Mailing Address - Country:US
Mailing Address - Phone:727-573-5626
Mailing Address - Fax:727-573-5627
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1115
Practice Address - Country:US
Practice Address - Phone:727-573-5626
Practice Address - Fax:727-573-5627
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064735207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23221XMedicare ID - Type Unspecified
FLF34031Medicare UPIN