Provider Demographics
NPI:1477584308
Name:SIGURNJAK, KATHRYN LAURA (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LAURA
Last Name:SIGURNJAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 TOMMY MUNRO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2134
Mailing Address - Country:US
Mailing Address - Phone:228-388-3993
Mailing Address - Fax:228-385-9941
Practice Address - Street 1:925 TOMMY MUNRO DR
Practice Address - Street 2:SUITE A
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2134
Practice Address - Country:US
Practice Address - Phone:228-388-3993
Practice Address - Fax:228-385-9941
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13562208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0115324Medicaid
MSF85950Medicare UPIN