Provider Demographics
NPI:1104026319
Name:KATZ, ILYA (DO)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 N 28TH DR STE 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5635
Mailing Address - Country:US
Mailing Address - Phone:602-971-0304
Mailing Address - Fax:602-971-0305
Practice Address - Street 1:11022 N 28TH DR STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-971-0304
Practice Address - Fax:602-971-0305
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242526208D00000X
AZ005220208D00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ437332Medicaid
AZZ141441Medicare PIN
AZZ130543Medicare PIN