Provider Demographics
NPI:1215049465
Name:CARMEL INTERNAL MEDICINE ASSOCIATES A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CARMEL INTERNAL MEDICINE ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LUDWIG
Authorized Official - Last Name:HOLZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:831-624-1864
Mailing Address - Street 1:26615 CARMEL CENTER PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8654
Mailing Address - Country:US
Mailing Address - Phone:831-624-1864
Mailing Address - Fax:831-624-4327
Practice Address - Street 1:26615 CARMEL CENTER PL
Practice Address - Street 2:SUITE 103
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8654
Practice Address - Country:US
Practice Address - Phone:831-624-1864
Practice Address - Fax:831-624-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ44934ZMedicare PIN