Provider Demographics
NPI:1548237951
Name:KATZ, ANDREW E (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7900 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4128
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-969-7266
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049117A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087408OtherANTHEM
OH0982512Medicaid
IN200191520Medicaid
IN260690LLMedicare PIN
INF85894Medicare UPIN
IN000000087408OtherANTHEM
OH0982512Medicaid