Provider Demographics
NPI:1275586919
Name:KATZMAN, BRAD A (DPM)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:KATZMAN
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 1:728 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762
Mailing Address - Country:US
Mailing Address - Phone:909-984-5614
Mailing Address - Fax:909-984-4759
Practice Address - Street 1:728 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:909-984-5614
Practice Address - Fax:909-984-4759
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2781213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E27810Medicaid
CA000E27810Medicare ID - Type Unspecified
CA000E27810Medicaid