Basic Information
| Provider Information | |||||||||
| NPI: | 1720084197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATTOLICO | ||||||||
| FirstName: | LEON | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 S WILLARD ST | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863266743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286345551 | ||||||||
| FaxNumber: | 9286345604 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N. BEAVER | ||||||||
| Address2: | PAYER CREDENTIALING | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282136235 | ||||||||
| FaxNumber: | 9282136292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS-3268-L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 3427 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 471467 | 05 | AZ | MEDICAID | 3427 | 01 | AZ | LICENSE | OTHER | AC-6555695 | 01 | D.E.A. | OTHER |