Provider Demographics
NPI:1285639963
Name:KATZ, ALLAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
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 1:715 E WESTERN RESERVE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3358
Mailing Address - Country:US
Mailing Address - Phone:339-965-3363
Mailing Address - Fax:330-729-7701
Practice Address - Street 1:715 E WESTERN RESERVE RD FL 2
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3358
Practice Address - Country:US
Practice Address - Phone:339-965-3363
Practice Address - Fax:330-729-7701
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009402L207RC0001X, 207RC0000X
OH34008150K207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2462697Medicaid
PA01961609Medicaid
PA01961609Medicaid
OH2462697Medicaid
PA055896-S3HMedicare ID - Type Unspecified