Provider Demographics
NPI:1316160724
Name:MICHELE MAHOLTZ MD PA
Entity type:Organization
Organization Name:MICHELE MAHOLTZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-978-1673
Mailing Address - Street 1:3725 12TH CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6589
Mailing Address - Country:US
Mailing Address - Phone:772-978-1673
Mailing Address - Fax:772-567-5561
Practice Address - Street 1:3725 12TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6589
Practice Address - Country:US
Practice Address - Phone:772-978-1673
Practice Address - Fax:772-567-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064054207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18800OtherBCBS
FLE74188Medicare UPIN
FLK7434Medicare ID - Type Unspecified