MEDICARE: DR. MARSHALL KATZMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306853676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL KATZMAN M.D.

Provider Business Mailing Address
First Line	:	3911 STATE ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62205-2146
Country	:	US
Telephone Number	:	618-482-7330
Fax Number	:	618-274-6437

Provider Business Practice Location Address
First Line	:	4601 STATE ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62205-1359
Country	:	US
Telephone Number	:	618-482-6420
Fax Number	:	618-274-6437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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