MEDICARE: DR. WILLIAM F HERHOLTZ III AU.D.

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	231H00000X	Audiologist	249	CO

General Provider Information

NPI Number	:	1174520811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM F HERHOLTZ III AU.D.

Provider Business Mailing Address
First Line	:	1396 S 21ST ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4261
Country	:	US
Telephone Number	:	719-520-3311
Fax Number	:	719-471-2823

Provider Business Practice Location Address
First Line	:	1396 S 21ST ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4261
Country	:	US
Telephone Number	:	719-520-3311
Fax Number	:	719-471-2823

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/17/2007

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