Provider Demographics
NPI:1538136478
Name:KATHLEEN S RATHBUN INC
Entity type:Organization
Organization Name:KATHLEEN S RATHBUN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-737-8960
Mailing Address - Street 1:4971 LE CHALET BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BOUNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:561-432-1544
Mailing Address - Fax:561-737-8960
Practice Address - Street 1:4971 LE CHALET BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BOUNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436
Practice Address - Country:US
Practice Address - Phone:561-432-1544
Practice Address - Fax:561-737-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7267207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57418Medicare ID - Type Unspecified
G75649Medicare UPIN