Kathryn K Bongo
Individual provider Active NPI Contractor · Indianapolis, IN
NPI 1164714945 · NPPES record last updated May 11, 2011
Key facts
- NPI
- 1164714945
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 23737 (FL)
- Practice address
- 5980 W 71St St Ste 102
Indianapolis, IN 46278-1785 - Phone
- (317) 388-0800
- Fax
- (317) 388-0805
- NPI assigned
- May 11, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23737 | FL | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Therapies,Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 23737 | FL | Yes |
Addresses
Primary practice location
5980 W 71St St Ste 102
Indianapolis, IN 46278-1785
Mailing address
5980 W 71St St Ste 102
Indianapolis, IN 46278-1785
Phone (317) 388-0800
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.