Healthcare Provider Details

I. General information

NPI: 1699748103
Provider Name (Legal Business Name): CRAIG S HOLZEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 HERITAGE HILLS DR
WASHINGTON MO
63090-4621
US

IV. Provider business mailing address

PO BOX 419052
SAINT LOUIS MO
63141-9052
US

V. Phone/Fax

Practice location:
  • Phone: 636-231-6660
  • Fax: 636-231-6663
Mailing address:
  • Phone: 314-851-1000
  • Fax: 314-851-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1H43
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: