Provider Demographics
NPI:1922077163
Name:KATZ, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:730 N MACOMB ST
Mailing Address - Street 2:STE 324
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2904
Mailing Address - Country:US
Mailing Address - Phone:734-243-4472
Mailing Address - Fax:
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:SUITE 324
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2900
Practice Address - Country:US
Practice Address - Phone:734-242-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080355207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H21598Medicare UPIN