Provider Demographics
NPI:1891979043
Name:HOLTHOUSER, MICHAEL GLEN (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GLEN
Last Name:HOLTHOUSER
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Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUTE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-624-4420
Mailing Address - Fax:970-624-4459
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-495-8450
Practice Address - Fax:970-297-6599
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2012-02-02
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Provider Licenses
StateLicense IDTaxonomies
CO196482083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58994Medicare UPIN