Healthcare Provider Details

I. General information

NPI: 1144223363
Provider Name (Legal Business Name): MARC A KATZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 W SWANN AVE STE 203
TAMPA FL
33609-4038
US

IV. Provider business mailing address

PO BOX 272284
TAMPA FL
33688-2284
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-0555
  • Fax: 866-313-3106
Mailing address:
  • Phone: 813-875-0555
  • Fax: 866-313-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2532
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2532
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO2532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: