Provider Demographics
NPI:1235904343
Name:OLTHOF, TODD WILLIAM
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:OLTHOF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7893
Mailing Address - Country:US
Mailing Address - Phone:231-780-7402
Mailing Address - Fax:
Practice Address - Street 1:ERIE INDUSTRIAL PARK BLDG 360
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-9412
Practice Address - Country:US
Practice Address - Phone:419-635-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3201001350146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic