Provider Demographics
NPI:1780666982
Name:KATZ, SHELLEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
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 1:5400 CANYON BLUFF TRL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8239
Mailing Address - Country:US
Mailing Address - Phone:505-508-1029
Mailing Address - Fax:
Practice Address - Street 1:5400 CANYON BLUFF TRL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-8239
Practice Address - Country:US
Practice Address - Phone:505-508-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK078965207RE0101X
NMRS2012-0788390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI142240OtherPREFERRED CHOICES
MIA4238872OtherAETNA PLANS
MI562533142OtherHARVARD PILGRIM NATIONAL
MI562533142OtherCHAMPUS TRICARE
MI104932923Medicaid
MI562533142OtherMICHIGAN TAX ID
MI6U4933OtherHEALTH ALLIANCE PLAN HMO
MISK078965OtherMICHIGAN STATE LICENSE
MI1108140971OtherBCBS OF MICHIGAN PIN
MI562533142OtherWASHTENAW HEALTH PLAN
MI562533142OtherUNITED HEALTH CARE PLANS
NMRS2012-0788OtherLICENSE NUMBER
MI0P23930OtherMICHIGAN MEDICARE PLUS BL
MI562533142OtherPPOM
MI562533142OtherCIGNA HEALTH PLANS
MI024544OtherMIDWEST HEALTH PLAN
MI142240OtherCARE CHOICES PIN
MI17388OtherM-CARE HMO
MI562533142OtherHARVARD PILGRIM NATIONAL
MIE37337Medicare UPIN