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General NPI Number Information
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NPI Number | 1104448372
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Entity Type | Individual
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Provider Name | JAKE KATZMAN DO
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Gender | Male
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 25150 FORD RD STE 100
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3163
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Country | US
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Telephone | 248-553-0010
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Fax | 248-553-5957
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Provider Business Mailing Address
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Address Line | 28595 ORCHARD LAKE RD STE 200
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2979
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Country | US
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Telephone | 248-553-0010
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Fax | 248-553-5957
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 5151014315
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License Number State | MI
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