Healthcare Provider Details

I. General information

NPI: 1104878750
Provider Name (Legal Business Name): NEAL JAY KATZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 W WASHINGTON AVE
MADISON WI
53703-2638
US

IV. Provider business mailing address

4033 COUNTY ROAD JJ
BLACK EARTH WI
53515-9729
US

V. Phone/Fax

Practice location:
  • Phone: 608-241-0848
  • Fax: 608-767-2015
Mailing address:
  • Phone: 608-225-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number424-025
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: