Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 424-025 | WI |
NPI | 1104878750 |
---|---|
Provider Name | Neal Jay Katz |
First Address | Black Earth, WI 53515-9729 |
Second Address | Madison, WI 53703-2638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 29/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3886620001 | MEDICARE DMEPOS (01) | WI |
406075 | DEAN HEALTH PLAN (01) | WI |
43204200 | (05) | WI |
T62379 | (02) | WI |