Basic Information
| Provider Information | |||||||||
| NPI: | 1629367354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUCIS | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | ALISE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVE | ||||||||
| Address2: | FLETCHER 309, MAILSTOP 201FL3 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028472700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2011 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 308808 | NY | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 01080417A | IN | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 390200000X | VT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207T00000X | 042-0015073 | VT | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.