Provider Demographics
NPI:1992731483
Name:PALONEN, KATRI P (MD)
Entity type:Individual
Prefix:
First Name:KATRI
Middle Name:P
Last Name:PALONEN
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 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-514-8891
Practice Address - Street 1:5130 SUNFOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6327
Practice Address - Country:US
Practice Address - Phone:727-824-0780
Practice Address - Fax:813-514-8891
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41392207R00000X
FLME133873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3811032Medicaid
FL023474000Medicaid
COCO307413Medicare PIN
TN4130607OtherTENNCARE
TN4130607OtherBCBS
TNP00331288OtherR/R MCR
TNP2131772OtherFIRST HEALTH
TNH78601Medicare UPIN
TN3811032Medicaid
TN7251819OtherAETNA