Provider Demographics
NPI:1093804643
Name:SIEGFRIED K HOLZ MD PA
Entity Type:Organization
Organization Name:SIEGFRIED K HOLZ MD PA
Other - Org Name:LAKELAND OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIEGFRIED
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-646-8955
Mailing Address - Street 1:3830 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1105
Mailing Address - Country:US
Mailing Address - Phone:863-646-8955
Mailing Address - Fax:863-648-5216
Practice Address - Street 1:3830 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1105
Practice Address - Country:US
Practice Address - Phone:863-646-8955
Practice Address - Fax:863-648-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2376442OtherAETNA - LAKELAND
FLV2921OtherBCBS - BRANDON
FL2376427OtherAETNA - BRANDON
FL257741103Medicaid
FL2577411Medicaid
FLV2920OtherBCBS - SUN CITY CENTER
FL2376434OtherAETNA TAMPA
FL257741101Medicaid
FL257741102Medicaid
FLV2922OtherBCBS - LAKELAND
FL257741100Medicaid
FL2376442OtherAETNA SUN CITY CENTER
FLV2923OtherBCBS - TAMPA
FL257741100Medicaid
FLV2920OtherBCBS - SUN CITY CENTER
FL257741103Medicaid