Provider Demographics
NPI:1811994999
Name:KATIN, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KATIN
Suffix:
Gender:M
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:PO BOX 947395
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7395
Mailing Address - Country:US
Mailing Address - Phone:401-356-1701
Mailing Address - Fax:401-356-4537
Practice Address - Street 1:115 CASS AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4705
Practice Address - Country:US
Practice Address - Phone:401-356-1701
Practice Address - Fax:401-356-4537
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00264272085R0001X
RIMD112852085R0001X
CAG266612085R0001X
NV48772085R0001X
NC2001-015672085R0001X
FLME264272085R0203X
NY127667-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4129712OtherAETNA PROVIDER NUMBER
FL592485899OtherMETCARE VENDOR ID #
FL00787OtherUNV. HLTHCR. PROVIDER #
NY01738807Medicaid
FL205786OtherAVMED PROVIDER NUMBER
FLMB505OtherMEDICARE
FLMB506OtherMEDICARE
FL24-05164OtherUTD. HLTHCR. PROVIDER #
FL0916153-016OtherCIGNA PROVIDER NUMBER
RIMD11285OtherLICENSE
CA00G26610Medicaid
FL065594500Medicaid
FL76715OtherOP. ENG. LOC. 825 PROV. #
FL985684OtherWELLCARE
NV2019966Medicaid
FL065594500Medicaid
FL79616ZMedicare PIN
FL24-05164OtherUTD. HLTHCR. PROVIDER #
NC2297378Medicare PIN
NY01738807Medicaid
NV30594Medicare PIN