1780666982 NPI number — DR. SHELLEY A KATZ M.D.

Table of content: DR. SHELLEY A KATZ M.D. (NPI 1780666982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780666982 NPI number — DR. SHELLEY A KATZ M.D.

Organization/Personal Information

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

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:
1780666982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 CANYON BLUFF TRL NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87111-8239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-508-1029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 CANYON BLUFF TRL NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87111-8239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-508-1029
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2005

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: 207RE0101X , with the licence number:  SK078965 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X , with the licence number: RS2012-0788 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 142240 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: A4238872 . This is a "AETNA PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 562533142 . This is a "HARVARD PILGRIM NATIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 562533142 . This is a "CHAMPUS TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104932923 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 562533142 . This is a "MICHIGAN TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6U4933 . This is a "HEALTH ALLIANCE PLAN HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: SK078965 . This is a "MICHIGAN STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108140971 . This is a "BCBS OF MICHIGAN PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 562533142 . This is a "WASHTENAW HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 562533142 . This is a "UNITED HEALTH CARE PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: RS2012-0788 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 0P23930 . This is a "MICHIGAN MEDICARE PLUS BL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 562533142 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 562533142 . This is a "CIGNA HEALTH PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 024544 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 142240 . This is a "CARE CHOICES PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 17388 . This is a "M-CARE HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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