Healthcare Provider Details

I. General information

NPI: 1033204201
Provider Name (Legal Business Name): GASTROENTEROLOGY & HEPATOLOGY ASSOCIATES OF MIDMICHIGAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 ORCHARD DR STE 3008
MIDLAND MI
48640-6100
US

IV. Provider business mailing address

4011 ORCHARD DR STE 3008
MIDLAND MI
48640-6100
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-0751
  • Fax: 989-839-9037
Mailing address:
  • Phone: 989-839-0751
  • Fax: 989-839-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD K HOLTZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 989-839-0751