Provider Demographics
NPI:1578636452
Name:KATZ, SHMUEL ERNO (MD)
Entity Type:Individual
Prefix:
First Name:SHMUEL
Middle Name:ERNO
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 1:10185 COLLINS AVE
Mailing Address - Street 2:SUITE 418
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1600
Mailing Address - Country:US
Mailing Address - Phone:305-864-7770
Mailing Address - Fax:305-864-7272
Practice Address - Street 1:100 NW 170TH ST
Practice Address - Street 2:WOUND CARE CLINIC SUITE 105
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5513
Practice Address - Country:US
Practice Address - Phone:305-654-5069
Practice Address - Fax:305-654-5217
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0038847208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045764700Medicaid
FL02269Medicare ID - Type Unspecified
FL045764700Medicaid