Provider Demographics
NPI:1083608772
Name:KATZ, LOUIS M (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
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 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-336-3125
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1853
Practice Address - Country:US
Practice Address - Phone:563-421-4244
Practice Address - Fax:563-421-4285
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20694207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421060724OtherBILLING TAX ID# FOR CHC
033967OtherHEALTH ALLIANCE
IL421060724007Medicaid
IA53200OtherIOWA BC/BS
IA42106072451OtherJOHN DEERE HEALTH
IL8122859OtherILLINOIS BC/BS
IA1214686OtherCONTROLLED SUBSTANCE#
IAIA0151OtherJOHN DEERE EDI#
IAIA0151OtherJOHN DEERE EDI#
IL421060724007Medicaid
IAIA0151OtherJOHN DEERE EDI#
IA421060724OtherBILLING TAX ID# FOR CHC
IA161822Medicare ID - Type UnspecifiedMEDICARE UGS
IA1214686OtherCONTROLLED SUBSTANCE#