Basic Information
| Provider Information | |||||||||
| NPI: | 1972590149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KATZ | ||||||||
| FirstName: | RAANANAH | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1776 N PINE ISLAND RD | ||||||||
| Address2: | STE 214 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333225233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544529922 | ||||||||
| FaxNumber: | 9544529481 | ||||||||
| Practice Location | |||||||||
| Address1: | 1776 N PINE ISLAND RD | ||||||||
| Address2: | STE 214 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333225233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544529922 | ||||||||
| FaxNumber: | 9544529481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME0036706 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 066157100 | 05 | FL | MEDICAID | 1024870001 | 01 | FL | DME | OTHER | 47578 | 01 | CA | LICENSE | OTHER | AK3025308 | 01 | FL | DEA | OTHER |