MEDICARE: MICHELE MAHOLTZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME64054	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME64054	OTHER	FL	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205807161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE MAHOLTZ MD

Provider Business Mailing Address
First Line	:	3725 12TH CT
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6543
Country	:	US
Telephone Number	:	772-567-0081
Fax Number	:	772-567-5561

Provider Business Practice Location Address
First Line	:	3725 12TH CT
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6543
Country	:	US
Telephone Number	:	772-567-0081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/29/2014

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