Provider Demographics
NPI:1245242601
Name:KATZ, MITCHEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:G
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1086 ELM ST
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067
Mailing Address - Country:US
Mailing Address - Phone:860-757-3352
Mailing Address - Fax:860-757-3704
Practice Address - Street 1:1086 ELM ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:860-757-3352
Practice Address - Fax:860-757-3704
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT028721208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG41767Medicare UPIN