Individual
KENNETH HENRY KATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 RANDOLPH CT, MANITOWOC, WI 54220-8345
(920) 683-5278
(920) 686-9674
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 683-5278
(920) 686-9674
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
39233020
WI
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
39233020
WI
207NS0135X
Procedural Dermatology Physician
39233020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32579200
—
WI
01
—
39233-020
STATE LICENSE
WI
01
—
O70016217
RAILROAD MEDICARE
WI
Enumeration date
06/14/2006
Last updated
03/07/2023
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