Provider Demographics
NPI:1235123019
Name:HOLTZ, MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HOLTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 PROVIDENCE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4201
Mailing Address - Country:US
Mailing Address - Phone:757-495-6113
Mailing Address - Fax:757-495-6156
Practice Address - Street 1:5253 PROVIDENCE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4201
Practice Address - Country:US
Practice Address - Phone:757-495-6113
Practice Address - Fax:757-495-6156
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101000452213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9300155Medicaid
T21426Medicare UPIN
VA480000496Medicare ID - Type Unspecified