Provider Demographics
NPI:1851589378
Name:MARC A. KATZ, DPM, PA
Entity Type:Organization
Organization Name:MARC A. KATZ, DPM, PA
Other - Org Name:ADVANCED PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-875-0555
Mailing Address - Street 1:PO BOX 272284
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-2284
Mailing Address - Country:US
Mailing Address - Phone:813-875-0555
Mailing Address - Fax:866-313-3106
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:STE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-875-0555
Practice Address - Fax:866-313-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2532213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA5546OtherRR MCARE GROUP ID
FL1144223363OtherINDIVIDUAL NPI
FL65499DOtherMCARE INDIVIDUAL
FLP02532OtherLICENSE
FLP00063086OtherRR MCARE INDIVIDUAL
FL003TGOtherBCBS GROUP
FL65499OtherBCBS
FLT69356Medicare UPIN
FLP00063086OtherRR MCARE INDIVIDUAL
FL5074920001Medicare NSC