Basic Information
| Provider Information | |||||||||
| NPI: | 1720027535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 CONCORD TER | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002433839 | ||||||||
| FaxNumber: | 2514705809 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 S ANDREWS AVE | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333162510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543554400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 12261 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009936165 | 05 | AL | MEDICAID | 1147427 | 05 | LA | MEDICAID | 51506879 | 01 | AL | BLUE CROSS | OTHER | 51518817 | 01 | AL | BLUE CROSS | OTHER | 00125124 | 05 | MS | MEDICAID | 160056309 | 01 | AL | RAILROAD MEDICARE PTAN | OTHER | 74-00030 | 01 | AL | UNITED HEALTH CARE | OTHER | 51506877 | 01 | AL | BLUE CROSS | OTHER | 51542411 | 01 | AL | BCBS - 1707 CENTER ST., STE 102 | OTHER | 51594001 | 01 | AL | BCBS - 150 S. INGLESIDE ST, STE 6 | OTHER | 51592379 | 01 | AL | BCBS - 2451 FILLINGIM | OTHER | 009978010 | 05 | AL | MEDICAID | 009978020 | 05 | AL | MEDICAID | 046648400 | 05 | FL | MEDICAID | 51544114 | 01 | AL | BCBS - 1700 CENTER ST | OTHER |