Provider Demographics
NPI:1487744496
Name:DR LUIS FELIX OXHOLM PC
Entity type:Organization
Organization Name:DR LUIS FELIX OXHOLM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:OXHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-935-0352
Mailing Address - Street 1:4020 COPPER VIEW DR.
Mailing Address - Street 2:SUITE 211
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7098
Mailing Address - Country:US
Mailing Address - Phone:231-935-0352
Mailing Address - Fax:231-935-8110
Practice Address - Street 1:4020 COPPER VIEW DR.
Practice Address - Street 2:SUITE 211
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7098
Practice Address - Country:US
Practice Address - Phone:231-935-0352
Practice Address - Fax:231-935-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDB8806OtherRAILROAD MCARE GRP.#
MIP00134275OtherRAILROAD MCARE IND. #
MIP81360OtherBLUE CARE NETWORK
MIF40586Medicare UPIN
MI0N93710Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MIDB8806OtherRAILROAD MCARE GRP.#