Provider Demographics
NPI:1932417094
Name:KATZ, MICHAEL LOUIS (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
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 1:550 FAIRBURN RD SW
Mailing Address - Street 2:B4
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2014
Mailing Address - Country:US
Mailing Address - Phone:813-368-9941
Mailing Address - Fax:
Practice Address - Street 1:550 FAIRBURN RD SW
Practice Address - Street 2:B4
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2014
Practice Address - Country:US
Practice Address - Phone:813-368-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66950208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine