MEDICARE: EMILY HOLZMAN CAMIENER RD

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	133V00000X	Registered Dietitian	819896	MI

General Provider Information

NPI Number	:	1871151548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY HOLZMAN CAMIENER RD

Provider Business Mailing Address
First Line	:	240 MILLRACE RD
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-3837
Country	:	US
Telephone Number	:	248-563-6866
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MAPLE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3148
Country	:	US
Telephone Number	:	248-885-8211
Fax Number	:

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	08/03/2021

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