Provider Demographics
NPI:1841427580
Name:COLTERYAHN, KATHRYN MCGOVERN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MCGOVERN
Last Name:COLTERYAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:MCGOVERN
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1351 RONALD REAGAN PKWY STE A
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6764
Practice Address - Country:US
Practice Address - Phone:317-217-2919
Practice Address - Fax:317-219-2916
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195204207R00000X
IN01070966A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201067620Medicaid
IN201067620Medicaid
INP01141655Medicare PIN