Healthcare Provider Details

I. General information

NPI: 1750383477
Provider Name (Legal Business Name): ROBERT D KATZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 COOPER CREEK BLVD STE 101
UNIVERSITY PARK FL
34201-2016
US

IV. Provider business mailing address

1800 CORTEZ RD W
BRADENTON FL
34207-1335
US

V. Phone/Fax

Practice location:
  • Phone: 941-360-9300
  • Fax: 941-360-9304
Mailing address:
  • Phone: 941-758-8818
  • Fax: 941-755-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2116
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: