Healthcare Provider Details

I. General information

NPI: 1598700601
Provider Name (Legal Business Name): RYAN D HOLZMACHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 S 110TH ST
GREENFIELD WI
53228-3131
US

IV. Provider business mailing address

19050 BLUE RIDGE CT
BROOKFIELD WI
53045-5103
US

V. Phone/Fax

Practice location:
  • Phone: 414-301-3531
  • Fax:
Mailing address:
  • Phone: 414-202-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number42642-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number42642-020
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42642-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: