Provider Demographics
NPI:1730111600
Name:HOLTZMAN, JEFFREY NEIL (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEIL
Last Name:HOLTZMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:ATTN: MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2221 HEALTH DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9700
Practice Address - Country:US
Practice Address - Phone:616-252-5710
Practice Address - Fax:616-252-5780
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006407207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16307003Medicare PIN
E26074Medicare UPIN
MI5101006407OtherMEDICAL LICENSE NUMBER
MI112744147Medicaid