MEDICARE: MICHAEL HOLTZ DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0101000452	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235123019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HOLTZ DPM

Provider Business Mailing Address
First Line	:	5253 PROVIDENCE RD
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4201
Country	:	US
Telephone Number	:	757-495-6113
Fax Number	:	757-495-6156

Provider Business Practice Location Address
First Line	:	5253 PROVIDENCE RD
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4201
Country	:	US
Telephone Number	:	757-495-6113
Fax Number	:	757-495-6156

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	03/08/2011

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