Healthcare Provider Details

I. General information

NPI: 1306853676
Provider Name (Legal Business Name): MARSHALL KATZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 STATE ST
EAST SAINT LOUIS IL
62205-1359
US

IV. Provider business mailing address

3911 STATE ST
EAST SAINT LOUIS IL
62205-2146
US

V. Phone/Fax

Practice location:
  • Phone: 618-482-6420
  • Fax: 618-274-6437
Mailing address:
  • Phone: 618-482-7330
  • Fax: 618-274-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: