Provider Demographics
NPI:1215900089
Name:KATONA, KEVIN REID (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:REID
Last Name:KATONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 WATERMELON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473
Mailing Address - Country:US
Mailing Address - Phone:205-752-7443
Mailing Address - Fax:205-556-8868
Practice Address - Street 1:4520 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473
Practice Address - Country:US
Practice Address - Phone:205-752-7443
Practice Address - Fax:205-556-8868
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051507167OtherBLUE CROSS BLUE SHIELD
AL051507167Medicaid
AL051507167Medicare ID - Type Unspecified
AL051507167OtherBLUE CROSS BLUE SHIELD