Provider Demographics
NPI:1982695375
Name:HOLTZ, TODD K (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:K
Last Name:HOLTZ
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 1:4230 BAY CITY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6014
Mailing Address - Country:US
Mailing Address - Phone:989-839-0750
Mailing Address - Fax:989-839-9037
Practice Address - Street 1:4230 BAY CITY RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-6014
Practice Address - Country:US
Practice Address - Phone:989-839-0750
Practice Address - Fax:989-839-9037
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITH053390207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3101974Medicaid
MI1005631202OtherBSBSM
MIF81509Medicare UPIN
MI0N11080003Medicare ID - Type Unspecified