MEDICARE: DR. LORI RAE HOLTZMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	31899	TN
2	208000000X	Pediatrics Physician	TNMD31899	TN
3	208000000X	Pediatrics Physician	31899	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023018587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI RAE HOLTZMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 381442
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1442
Country	:	US
Telephone Number	:	901-350-2639
Fax Number	:	901-249-4563

Provider Business Practice Location Address
First Line	:	2565 HORIZON LAKE DR STE 114
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-8113
Country	:	US
Telephone Number	:	901-350-2639
Fax Number	:	901-249-4563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	03/22/2022

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