Provider Demographics
NPI:1760530869
Name:KATZ, MARTHA MERCEDES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MERCEDES
Last Name:KATZ
Suffix:
Gender:F
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 651396
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-1396
Mailing Address - Country:US
Mailing Address - Phone:305-559-8148
Mailing Address - Fax:
Practice Address - Street 1:810 WEST MOWRY STREET
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:305-242-2008
Practice Address - Fax:305-242-2010
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256717200Medicaid
26435Medicare PIN
FL256717200Medicaid