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NPI Code Detail

MEDICARE: MICHAEL RAY HOLTGREWE MD

MEDICARE: MICHAEL RAY HOLTGREWE 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
1208D00000XGeneral Practice Physician35.043477OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P01254615OTHEROHRAILROAD MEDICARE - MHCPI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000728056OTHEROHANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000727930OTHEROHANTHEM
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235134578
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL RAY HOLTGREWE MD
Provider Business Mailing Address
First Line : PO BOX 449
Second Line :
City : MARIETTA
State : OH
Zip : 45750-0449
Country : US
Telephone Number : 740-374-4500
Fax Number : 740-374-5887
Provider Business Practice Location Address
First Line : 401 MATTHEW ST
Second Line : WOUND CARE CENTER
City : MARIETTA
State : OH
Zip : 45750-1635
Country : US
Telephone Number : 740-374-1623
Fax Number : 740-568-5355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 02/17/2014

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Directions to “ MICHAEL RAY HOLTGREWE MD” Practice Location

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