Provider Demographics
NPI:1306070172
Name:ZECHAR, KATIE R (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:R
Last Name:ZECHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BURGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:44428 WOODWARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5009
Mailing Address - Country:US
Mailing Address - Phone:248-858-3126
Mailing Address - Fax:
Practice Address - Street 1:44428 WOODWARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5009
Practice Address - Country:US
Practice Address - Phone:248-858-3126
Practice Address - Fax:248-858-6499
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068426208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01089552OtherRAILROAD MEDICARE
GA003126552AMedicaid
706079OtherWELLCARE
SCGA1367Medicaid
01685274OtherAMERIGROUP
GA20211I8712Medicare PIN