Healthcare Provider Details

I. General information

NPI: 1245242601
Provider Name (Legal Business Name): MITCHEL G KATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 116TH AVE NE STE 200B
BELLEVUE WA
98004-3097
US

IV. Provider business mailing address

710 S 348TH ST
FEDERAL WAY WA
98003-7042
US

V. Phone/Fax

Practice location:
  • Phone: 425-276-1825
  • Fax: 855-785-8770
Mailing address:
  • Phone: 425-486-2926
  • Fax: 855-785-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number028721
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number70050328
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number028721
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: