Provider Demographics
NPI:1740589944
Name:SHMUEL E KATZ MD PA
Entity Type:Organization
Organization Name:SHMUEL E KATZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-864-7770
Mailing Address - Street 1:10185 COLLINS AVE APT 418
Mailing Address - Street 2:
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1606
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: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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045764700Medicaid
FLD84717Medicare UPIN
FL02269Medicare PIN