1083608772 NPI number — LOUIS M KATZ M.D.

Table of content: LOUIS M KATZ M.D. (NPI 1083608772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083608772 NPI number — LOUIS M KATZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATZ
Provider First Name:
LOUIS
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083608772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52801-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-336-3000
Provider Business Mailing Address Fax Number:
563-336-3125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 W CENTRAL PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52804-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-421-4244
Provider Business Practice Location Address Fax Number:
563-421-4285
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  20694 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 421060724 . This is a "BILLING TAX ID# FOR CHC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 033967 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421060724007 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53200 . This is a "IOWA BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42106072451 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 8122859 . This is a "ILLINOIS BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1214686 . This is a "CONTROLLED SUBSTANCE#" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0151 . This is a "JOHN DEERE EDI#" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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