Provider Demographics
NPI:1760460356
Name:HOLTZMEIER, BRANT (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANT
Middle Name:
Last Name:HOLTZMEIER
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:PO BOX 74696
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0779
Mailing Address - Country:US
Mailing Address - Phone:440-808-8620
Mailing Address - Fax:440-899-4372
Practice Address - Street 1:25651 DETROIT RD STE 304
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2415
Practice Address - Country:US
Practice Address - Phone:440-808-8620
Practice Address - Fax:440-899-4372
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2172492Medicaid
OH0890549Medicare PIN