Provider Demographics
NPI:1699748103
Name:HOLZEM, CRAIG S (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:HOLZEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419052
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9052
Mailing Address - Country:US
Mailing Address - Phone:314-851-1000
Mailing Address - Fax:314-851-4449
Practice Address - Street 1:1721 HERITAGE HILLS DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4621
Practice Address - Country:US
Practice Address - Phone:636-231-6660
Practice Address - Fax:636-231-6663
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1H43207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202945234Medicaid
080121826OtherRAILROAD MEDICARE
MOP01134647OtherRAILROAD MEDICARE
MOP01134647OtherRAILROAD MEDICARE
E68808Medicare UPIN
002012943Medicare PIN
MO202945234Medicaid