Provider Demographics
NPI:1194713750
Name:BIRD, CATHERINE P (DO)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:P
Last Name:BIRD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:PESEK BIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3450 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5461
Mailing Address - Country:US
Mailing Address - Phone:312-513-3395
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-6120
Practice Address - Fax:319-356-4559
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02875207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1141473Medicaid
IA40635OtherWELLMARK BCBS
IA40635Medicare PIN
IA40635OtherWELLMARK BCBS