Provider Demographics
NPI:1457355109
Name:KATZ, HOWARD (DO)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8243 MANOR GATE WAY
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5969
Mailing Address - Country:US
Mailing Address - Phone:216-443-0430
Mailing Address - Fax:
Practice Address - Street 1:1375 E. 9TH
Practice Address - Street 2:STE 1850
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-443-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO65208600000X
OH002483208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0529299Medicaid
AL009974140Medicaid
OHKA0538183OtherMEDICARE
AL009974140Medicaid
OHCO3523Medicare UPIN
OHKA0538183OtherMEDICARE