Healthcare Provider Details

I. General information

NPI: 1063900645
Provider Name (Legal Business Name): JOHN CHRISTIAN HOLTROP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 S 12TH ST STE 100
PORTAGE MI
49024-3831
US

IV. Provider business mailing address

7901 S 12TH ST STE 100
PORTAGE MI
49024-3831
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-3000
  • Fax: 269-372-3500
Mailing address:
  • Phone: 269-372-3000
  • Fax: 269-372-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number335669
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301518248
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: