Provider Demographics
NPI:1093245375
Name:CAPP, KATIE LYNN (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:CAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MCAULEY PL STE 600
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4778
Mailing Address - Country:US
Mailing Address - Phone:419-996-2686
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 240
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5906
Practice Address - Country:US
Practice Address - Phone:419-996-2686
Practice Address - Fax:419-996-2687
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61473997207R00000X, 207RP1001X
OH35.153753207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty