Provider Demographics
NPI:1376611814
Name:KAATZ, SCOTT S (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:KAATZ
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 1:2799 W. GRAND BLVD
Mailing Address - Street 2:HENRY FORD HOSPITAL
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-8144
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:HENRY FORD HOSPIATL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008607207R00000X
MIBK2777007208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI258181011Medicaid
MI1376611814Medicaid
700H262220OtherBLUE CROSS-BLUE CROSS
SK008607OtherCHAMPUS-CHAMPUS
SK008607OtherCOMMERCIAL-COMMERCIAL NUMBER
SK008607OtherCOMMERCIAL-COMMERCIAL NUMBER