Provider Demographics
NPI:1154374106
Name:HOLZ, LYNNE ANN (MD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANN
Last Name:HOLZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LYNNE
Other - Middle Name:ANN
Other - Last Name:EZERSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12324 W 101ST TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-1808
Mailing Address - Country:US
Mailing Address - Phone:785-227-3371
Mailing Address - Fax:785-227-3004
Practice Address - Street 1:12324 W 101ST TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1808
Practice Address - Country:US
Practice Address - Phone:785-227-3371
Practice Address - Fax:785-227-3004
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431527207Q00000X
NE17221207Q00000X
AK4966207Q00000X
MT9697207Q00000X
ORMD24012207Q00000X
IDM8326207Q00000X
SD5302207Q00000X
MDD0056833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28777Medicare UPIN