MEDICARE: ROGER HOLOWACH

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1902748411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER HOLOWACH

Provider Business Mailing Address
First Line	:	516 KALAMAZOO AVE
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2743
Country	:	US
Telephone Number	:	231-340-4945
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 KALAMAZOO AVE
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2743
Country	:	US
Telephone Number	:	231-340-4945
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ ROGER HOLOWACH ” Practice Location

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