Healthcare Provider Details

I. General information

NPI: 1144337593
Provider Name (Legal Business Name): AVI KATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax: 612-365-8001
Mailing address:
  • Phone: 612-365-6777
  • Fax: 612-365-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number29458
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: