Healthcare Provider Details

I. General information

NPI: 1164826137
Provider Name (Legal Business Name): MICHAEL M. CATZ, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 E. NORTH STREET
MANTECA CA
95336
US

IV. Provider business mailing address

817 COFFEE RD C3
MODESTO CA
95355-4241
US

V. Phone/Fax

Practice location:
  • Phone: 209-823-3111
  • Fax:
Mailing address:
  • Phone: 209-529-9603
  • Fax: 209-529-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA40711
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA40711
License Number StateCA

VIII. Authorized Official

Name: MICHAEL M CATZ
Title or Position: PRESIDENT
Credential: MD
Phone: 818-923-3485