MEDICARE: MATTHEW C. HOLTZMAN M.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	2084N0600X	Clinical Neurophysiology Physician	4301081479	MI
2	2084N0400X	Neurology Physician	4301081479	MI

General Provider Information

NPI Number	:	1275741647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW C. HOLTZMAN M.D.

Provider Business Mailing Address
First Line	:	34815 W MICHIGAN AVE
Second Line	:	C
City	:	WAYNE
State	:	MI
Zip	:	48184-1799
Country	:	US
Telephone Number	:	734-721-4739
Fax Number	:	734-725-3184

Provider Business Practice Location Address
First Line	:	34815 W MICHIGAN AVE
Second Line	:	C
City	:	WAYNE
State	:	MI
Zip	:	48184-1799
Country	:	US
Telephone Number	:	734-721-4739
Fax Number	:	734-725-3184

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	10/11/2017

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