Provider Demographics
NPI:1992792212
Name:KATZ, LON ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:LON
Middle Name:ERIC
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 1:2300 HAGGERTY RD
Mailing Address - Street 2:STE 2070
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-926-2020
Mailing Address - Fax:248-926-9020
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:STE 2070
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-926-2020
Practice Address - Fax:248-926-9020
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILK052894207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F32178OtherBLUE CROSS GROUP PIN
MI1992792212OtherNPI
MI4467396Medicaid
MIN64200003Medicare ID - Type Unspecified
MI4467396Medicaid