Provider Demographics
NPI:1740597467
Name:HOLZMAN, BERNARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:H
Last Name:HOLZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 SE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1989
Mailing Address - Country:US
Mailing Address - Phone:305-230-1643
Mailing Address - Fax:305-230-1644
Practice Address - Street 1:1855 SE 19TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1989
Practice Address - Country:US
Practice Address - Phone:305-230-1643
Practice Address - Fax:305-230-1644
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037157200Medicaid
FL037157200Medicaid