Provider Demographics
NPI:1255329355
Name:KATZ, GARY R (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:29992 NORTHWESTERN HWY
Mailing Address - Street 2:STE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-681-8282
Mailing Address - Fax:
Practice Address - Street 1:27483 DEQUINDRE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3491
Practice Address - Country:US
Practice Address - Phone:248-546-2600
Practice Address - Fax:248-546-2604
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-12-11
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Provider Licenses
StateLicense IDTaxonomies
MI5101011790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255329355Medicaid
MI4522550Medicaid
MIG30120Medicare UPIN