Provider Demographics
NPI:1205924230
Name:KATZ, RICHARD S (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4558
Mailing Address - Country:US
Mailing Address - Phone:847-272-0005
Mailing Address - Fax:847-272-0788
Practice Address - Street 1:1275 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4558
Practice Address - Country:US
Practice Address - Phone:847-272-0005
Practice Address - Fax:847-272-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031603265OtherBLUE CROSS PROVIDER NUMBE
IL0031603265OtherBLUE CROSS PROVIDER NUMBE
ILC37562Medicare UPIN