Provider Demographics
NPI:1902879489
Name:KATZ, MICHAEL DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:KATZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 SIX FORKS RD
Mailing Address - Street 2:STE. 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5250
Mailing Address - Country:US
Mailing Address - Phone:919-781-0852
Mailing Address - Fax:919-781-1589
Practice Address - Street 1:4816 SIX FORKS RD
Practice Address - Street 2:STE. 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5250
Practice Address - Country:US
Practice Address - Phone:919-781-0852
Practice Address - Fax:919-781-1589
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC768103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04017OtherBLUE CROSS BLUE SHIELD-NC