Provider Demographics
NPI:1558516559
Name:KATZUNG, BERTRAM G
Entity Type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:G
Last Name:KATZUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3626
Mailing Address - Country:US
Mailing Address - Phone:415-456-5812
Mailing Address - Fax:415-459-0688
Practice Address - Street 1:65 KNOLL RD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3626
Practice Address - Country:US
Practice Address - Phone:415-456-5812
Practice Address - Fax:415-459-0688
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5165208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice