Provider Demographics
NPI:1104878750
Name:KATZ, NEAL JAY (DPM)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:JAY
Last Name:KATZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 COUNTY ROAD JJ
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-9729
Mailing Address - Country:US
Mailing Address - Phone:608-225-1529
Mailing Address - Fax:
Practice Address - Street 1:664 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2638
Practice Address - Country:US
Practice Address - Phone:608-241-0848
Practice Address - Fax:608-767-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI424-025213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3886620001OtherMEDICARE DMEPOS
WI43204200Medicaid
WI406075OtherDEAN HEALTH PLAN
WI84517Medicare ID - Type UnspecifiedPROVIDER NUMBER
WI3886620001OtherMEDICARE DMEPOS