Provider Demographics
NPI:1699955518
Name:HUTCHISON-ULLOA, KATHERINE ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:HUTCHISON-ULLOA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:86 COLUMBUS CIR
Practice Address - Street 2:#203
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1371
Practice Address - Country:US
Practice Address - Phone:740-249-4122
Practice Address - Fax:740-249-4126
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3067078Medicaid
OH3067078Medicaid
OH4293421Medicare PIN
OH3067078Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH4293421Medicare PIN