Kathryn Dittmer, DVM
Individual provider Active NPI Specialist · Portage, IN
NPI 1679010342 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1679010342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 24007755A (IN)
- Practice address
- 3411 Airport Rd
Portage, IN 46368-5107 - Phone
- (219) 763-3311
- NPI assigned
- Jan 19, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 24007755A | IN | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 24007755A | IN | Yes |
Addresses
Primary practice location
3411 Airport Rd
Portage, IN 46368-5107
Mailing address
3411 Airport Rd
Portage, IN 46368-5107
Phone (219) 763-3311
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 076262 | Other | FEDERAL LICENSE | |
| 258557 | Other | AVMA | |
| 24007755A | Other | IN | VETERINARY LICENSE |
Other providers in Portage, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. 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.