Provider Demographics
NPI:1588746572
Name:KATZ, SHERMAN A (MD)
Entity type:Individual
Prefix:DR
First Name:SHERMAN
Middle Name:A
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:DUNCAN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:43734-0277
Mailing Address - Country:US
Mailing Address - Phone:740-280-0001
Mailing Address - Fax:740-280-0002
Practice Address - Street 1:377 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN FALLS
Practice Address - State:OH
Practice Address - Zip Code:43734-9763
Practice Address - Country:US
Practice Address - Phone:740-280-0001
Practice Address - Fax:740-280-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350393662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0369551Medicaid
OH4085964Medicare PIN
OH0369551Medicaid