Provider Demographics
NPI:1831862325
Name:KATUREEBE MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:KATUREEBE MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-901-6120
Mailing Address - Street 1:290 BLUE SPRUCE TRL
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7060
Mailing Address - Country:US
Mailing Address - Phone:617-901-6120
Mailing Address - Fax:
Practice Address - Street 1:290 BLUE SPRUCE TRL
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-7060
Practice Address - Country:US
Practice Address - Phone:617-901-6120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty