Provider Demographics
NPI:1881198190
Name:HOLZEMER, JACOB R (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:R
Last Name:HOLZEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:HOLZEMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2101
Mailing Address - Fax:614-293-9155
Practice Address - Street 1:1581 DODD DR FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1257
Practice Address - Country:US
Practice Address - Phone:614-293-2101
Practice Address - Fax:614-293-9155
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.148935208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery