Provider Demographics
NPI:1811994999
Name:KATIN, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KATIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 BOY SCOUT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1179
Practice Address - Street 1:15681 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4123
Practice Address - Country:US
Practice Address - Phone:239-437-1977
Practice Address - Fax:239-437-1889
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48772085R0001X
CAG266612085R0001X
FLME00264272085R0001X
NC2001-015672085R0001X
NY127667-12085R0001X
FLME264272085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0916153-016OtherCIGNA PROVIDER NUMBER
FL985684OtherWELLCARE
FLMB505OtherMEDICARE
FL205786OtherAVMED PROVIDER NUMBER
FL24-05164OtherUTD. HLTHCR. PROVIDER #
FLMB506OtherMEDICARE
CA00G26610Medicaid
FL065594500Medicaid
FL592485899OtherMETCARE VENDOR ID #
FL00787OtherUNV. HLTHCR. PROVIDER #
NV2019966Medicaid
FL4129712OtherAETNA PROVIDER NUMBER
NY01738807Medicaid
FL76715OtherOP. ENG. LOC. 825 PROV. #
NV2019966Medicaid
FL065594500Medicaid
FL79616ZMedicare PIN
FL24-05164OtherUTD. HLTHCR. PROVIDER #
NC2297378Medicare PIN
NY01738807Medicaid
NV30594Medicare PIN