MEDICARE: DR. DAVID G HOLZWORTH D.O.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	5101006598	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P46665	OTHER	MI	BLUE CARE NETWORK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1758239605	OTHER	MI	BLUE CROSS MICHIGAN
4	C5092	OTHER	MI	MCARE

General Provider Information

NPI Number	:	1205828910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID G HOLZWORTH D.O.

Provider Business Mailing Address
First Line	:	14600 KING RD
Second Line	:	SUITE D
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7952
Country	:	US
Telephone Number	:	734-479-7310
Fax Number	:	734-479-7307

Provider Business Practice Location Address
First Line	:	14600 KING RD
Second Line	:	SUITE D
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7952
Country	:	US
Telephone Number	:	734-479-7310
Fax Number	:	734-479-7307

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/13/2008

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