Healthcare Provider Details

I. General information

NPI: 1851589378
Provider Name (Legal Business Name): MARC A. KATZ, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 09/23/2014
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 TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2532
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO2532
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2532
License Number StateFL

VIII. Authorized Official

Name: DR. MARC A KATZ
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 813-875-0555