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NPI Code Detail

MEDICARE: MR. ERIC KATZENBERGER ATC

MEDICARE: MR. ERIC KATZENBERGER ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer88-039WI
22255A2300XAthletic TrainerIL

General Provider Information

NPI Number : 1730156092
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC KATZENBERGER ATC
Provider Business Mailing Address
First Line : N1153 CLARNO RD
Second Line :
City : MONROE
State : WI
Zip : 53566-9631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 515 22ND AVE
Second Line :
City : MONROE
State : WI
Zip : 53566-1569
Country : US
Telephone Number : 608-325-7529
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2006
Last Update Date : 07/08/2007

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