Provider Demographics
NPI:1932388915
Name:HOLZ, SIEGFRIED K (MD)
Entity Type:Individual
Prefix:DR
First Name:SIEGFRIED
Middle Name:K
Last Name:HOLZ
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 1:3830 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1105
Mailing Address - Country:US
Mailing Address - Phone:863-646-8955
Mailing Address - Fax:863-709-8426
Practice Address - Street 1:3830 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1105
Practice Address - Country:US
Practice Address - Phone:863-646-8955
Practice Address - Fax:863-648-5216
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2922OtherBC/BS
FLV2921OtherBC/BS
FLV2923OtherBC/BS
FL257741100Medicaid
FL257741103Medicaid
FL257741101Medicaid
FL257741102Medicaid
FLV2920OtherBC/BS
FL257741100Medicaid
FL257741101Medicaid