Provider Demographics
NPI:1013024140
Name:KATZ, WILLIAM MARC (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARC
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WEALTHY ST SE
Mailing Address - Street 2:STE 150
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2969
Mailing Address - Country:US
Mailing Address - Phone:616-459-3158
Mailing Address - Fax:616-459-4714
Practice Address - Street 1:2093 HEALTH DR SW
Practice Address - Street 2:STE 200
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-459-3158
Practice Address - Fax:616-819-2222
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044867207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104106031OtherBCBS OF MICHIGAN
38-2145264OtherIRS TAX ID# THRU CORP
MI1896734Medicaid
MI1896734Medicaid
MI0D16122006Medicare PIN