Provider Demographics
NPI:1619919578
Name:KATZ, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
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:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:800-514-4390
Mailing Address - Fax:440-808-3676
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:419-996-5033
Practice Address - Fax:419-996-5266
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0926912084P0800X
IL0361151012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06132032OtherBCBS
ILCG2264OtherRR GROUP
OHP00712995OtherMEDICARE GROUP RR
OH2915644Medicaid
OH2915644Medicaid
ILD05369Medicare UPIN
ILCG2264OtherRR GROUP