Healthcare Provider Details

I. General information

NPI: 1982695375
Provider Name (Legal Business Name): TODD K HOLTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 BAY CITY RD
MIDLAND MI
48642-6014
US

IV. Provider business mailing address

4230 BAY CITY RD
MIDLAND MI
48642-6014
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-0750
  • Fax: 989-839-9037
Mailing address:
  • Phone: 989-839-0750
  • Fax: 989-839-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberTH053390
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: