Provider Demographics
NPI:1114039153
Name:KATICS, MATTHEW JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:KATICS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ELLA ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4165
Mailing Address - Country:US
Mailing Address - Phone:805-549-9555
Mailing Address - Fax:805-549-0444
Practice Address - Street 1:1325 E CHURCH ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5915
Practice Address - Country:US
Practice Address - Phone:805-346-3456
Practice Address - Fax:805-346-3454
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9228207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF408AMedicare PIN