Provider Demographics
NPI:1447363213
Name:EVAN KATZ MDPA
Entity type:Organization
Organization Name:EVAN KATZ MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-5440
Mailing Address - Street 1:6280 SUNSET DR STE 609
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4875
Mailing Address - Country:US
Mailing Address - Phone:305-661-5440
Mailing Address - Fax:305-662-4178
Practice Address - Street 1:6280 SUNSET DR STE 609
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4875
Practice Address - Country:US
Practice Address - Phone:305-661-5440
Practice Address - Fax:305-662-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME7904174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL468336Medicare UPIN
FL90391Medicare ID - Type Unspecified