Provider Demographics
NPI:1306853676
Name:KATZMAN, MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:KATZMAN
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 1:3911 STATE ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62205-2146
Mailing Address - Country:US
Mailing Address - Phone:618-482-7330
Mailing Address - Fax:618-274-6437
Practice Address - Street 1:4601 STATE ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-1359
Practice Address - Country:US
Practice Address - Phone:618-482-6420
Practice Address - Fax:618-274-6437
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0283462048Medicaid
ILA10578Medicare UPIN
IL950140/L17060Medicare ID - Type Unspecified