Provider Demographics
NPI:1215034103
Name:KAUTZ, KATHLEEN EDNA (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:EDNA
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:EDNA
Other - Last Name:SCHICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1029 KEYSER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6215
Mailing Address - Country:US
Mailing Address - Phone:318-352-7768
Mailing Address - Fax:318-357-3661
Practice Address - Street 1:1029 KEYSER AVENUE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6239
Practice Address - Country:US
Practice Address - Phone:318-238-6001
Practice Address - Fax:318-238-6002
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15485R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2101803Medicaid
LA1471704Medicaid
H34190Medicare UPIN
LA1471704Medicaid
6443890001Medicare NSC
LA5CM46Medicare ID - Type Unspecified
6443890002Medicare NSC
5DL99Medicare PIN