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General NPI Number Information
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NPI Number | 1316160724
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Entity Type | Organization
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Legal Business Name | MICHELE MAHOLTZ MD PA
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 3725 12TH CT
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City | VERO BEACH
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State | FL
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Zip | 32960-6589
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Country | US
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Telephone | 772-978-1673
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Fax | 772-567-5561
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Provider Business Mailing Address
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Address Line | 3725 12TH CT
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City | VERO BEACH
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State | FL
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Zip | 32960-6589
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Country | US
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Telephone | 772-978-1673
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Fax | 772-567-5561
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELE MAHOLTZ
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Credential | MD
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Telephone | 772-978-1673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME0064054
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License Number State | FL
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