Basic Information
| Provider Information | |||||||||
| NPI: | 1881631521 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KATOLIK | ||||||||
| FirstName: | LEONID | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 PULASKI DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194062802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107685940 | ||||||||
| FaxNumber: | 6107685947 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 PULASKI DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194062802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107685940 | ||||||||
| FaxNumber: | 6107685947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 06/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD432724 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD00042609 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | MD00042609 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0106X | MD432724 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00151768 | 01 | WA | RAILROAD MEDICARE | OTHER | 3321655000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 3321655000 | 01 | PA | KEYSTONE HEALTHPLAN EAST | OTHER | 2010586 | 01 | PA | PENNSYLVANIA BLUE SHIELD | OTHER |