Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101006598 | MI |
NPI | 1205828910 |
---|---|
Provider Name | Dr. David G Holzworth |
First Address | Riverview, MI 48193-7952 |
Second Address | Riverview, MI 48193-7952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 13/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1302187 | (05) | MI |
1758239605 | BLUE CROSS MICHIGAN (01) | MI |
C5092 | MCARE (01) | MI |
E25689 | (02) | MI |
P46665 | BLUE CARE NETWORK (01) | MI |