Provider Demographics
NPI:1346317179
Name:KATZ, TYLER JESSICA (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JESSICA
Last Name:KATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:MACDONALD WOMEN'S HOSPITAL, 7TH FLOOR
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-844-3921
Mailing Address - Fax:216-201-4239
Practice Address - Street 1:11000 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1714
Practice Address - Country:US
Practice Address - Phone:216-201-4239
Practice Address - Fax:216-201-4239
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH090465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000564039OtherANTHEM BLUE SHIELD
OH000000564657OtherANTHEM BLUE SHIELD
OH420570OtherWELLCARE
OH2788407Medicaid
OH000000564657OtherANTHEM BLUE SHIELD
P00467398Medicare PIN
OH4222391Medicare PIN
OH7417541Medicare PIN
OH2788407Medicaid