Provider Demographics
NPI:1861873127
Name:KENNETH E KATZ MD PC
Entity type:Organization
Organization Name:KENNETH E KATZ MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-779-3013
Mailing Address - Street 1:8120 S HOLLY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4005
Mailing Address - Country:US
Mailing Address - Phone:303-779-3013
Mailing Address - Fax:303-779-0343
Practice Address - Street 1:8120 S HOLLY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4005
Practice Address - Country:US
Practice Address - Phone:303-779-3013
Practice Address - Fax:303-779-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1144211897OtherTYPE 1 NPI