Provider Demographics
NPI:1053315705
Name:KATZ, LINDA KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KATHLEEN
Last Name:KATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JOHN SUTHERLAND DR
Mailing Address - Street 2:STE 3
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2424
Mailing Address - Country:US
Mailing Address - Phone:859-881-1400
Mailing Address - Fax:859-881-3489
Practice Address - Street 1:100 JOHN SUTHERLAND DR
Practice Address - Street 2:STE 3
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2424
Practice Address - Country:US
Practice Address - Phone:859-881-1400
Practice Address - Fax:859-881-3489
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35266207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64007511Medicaid
KY180045912OtherRAILROAD MEDICARE ID
KY7750007OtherAETNA PROVIDER ID
KY000000240538OtherANTHEM 12 DIGIT ID
KY42293OtherDAVIS VISION PROVIDER ID
KY64007511Medicaid
KY0728401Medicare PIN
H01312Medicare UPIN
7284Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER