Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 29458 | MN |
NPI | 1144337593 |
---|---|
Provider Name | Avi Katz |
First Address | Minneapolis, MN 55454-1404 |
Second Address | Minneapolis, MN 55454-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 06/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051509751 | (02) | |
H64734 | (02) |