Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 4301044867 | MI |
N | 207RP1001X | Pulmonary Disease | 4301044867 | MI |
Y | 207RS0012X | Sleep Medicine | 4301044867 | MI |
NPI | 1013024140 |
---|---|
Provider Name | William Marc Katz |
First Address | Grand Rapids, MI 49506-2969 |
Second Address | Wyoming, MI 49519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 22/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104106031 | BCBS OF MICHIGAN (01) | MI |
1896734 | (05) | MI |
38-2145264 | IRS TAX ID# THRU CORP (01) | |
A76868 | (02) |