Provider Demographics
NPI:1689762429
Name:HORWITZ, MICHAEL H (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:HORWITZ
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 1:8637 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1906
Mailing Address - Country:US
Mailing Address - Phone:314-983-0303
Mailing Address - Fax:314-983-2777
Practice Address - Street 1:8637 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1906
Practice Address - Country:US
Practice Address - Phone:314-983-0303
Practice Address - Fax:314-983-2777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO603213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO212080001OtherMEDICARE PTAN
MOT90007Medicare UPIN