Provider Demographics
NPI:1609800986
Name:CATAFYGOITU, JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CATAFYGOITU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13080 COLDWATER CIR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6037
Mailing Address - Country:US
Mailing Address - Phone:662-420-9637
Mailing Address - Fax:
Practice Address - Street 1:2743 MARIAH LN
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7166
Practice Address - Country:US
Practice Address - Phone:662-420-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80184213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09183267Medicaid
MS09457317Medicaid
MS512G700247Medicare UPIN
MS09183267Medicaid