Healthcare Provider Details

I. General information

NPI: 1801910617
Provider Name (Legal Business Name): MARK F HOELTZEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR 8TH FLOOR C.S. MOTT CHILDREN'S HOSPITAL
ANN ARBOR MI
48108-4259
US

IV. Provider business mailing address

3621 SOUTH STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4185
  • Fax: 734-936-9090
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301083829
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number2007014909
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number4301083829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: