Healthcare Provider Details

I. General information

NPI: 1316260797
Provider Name (Legal Business Name): PETER F KOLTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 11/03/2023
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7634 W CENTRAL AVE
TOLEDO OH
43617-1526
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 567-408-7356
  • Fax: 567-408-7355
Mailing address:
  • Phone: --
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD456615
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.131569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: