=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477641066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRY IRVING KATZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 DELAWARE STREET S.E. PWB FIFTH FLOOR, CLINIC 5A
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-625-5656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 DELAWARE ST SE MM 98 UNIVERSITY OF MINNESOTA PHYSICIANS
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-625-5656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 15870
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------