MEDICARE: MICHELE MAHOLTZ MD PA

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	207RP1001X	Pulmonary Disease Physician	ME0064054	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18800	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316160724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELE MAHOLTZ MD PA

Provider Business Mailing Address
First Line	:	3725 12TH CT
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6589
Country	:	US
Telephone Number	:	772-978-1673
Fax Number	:	772-567-5561

Provider Business Practice Location Address
First Line	:	3725 12TH CT
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6589
Country	:	US
Telephone Number	:	772-978-1673
Fax Number	:	772-567-5561

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHELE MAHOLTZ
Credential	:	MD
Telephone Number	:	772-978-1673

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	01/28/2008

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