Provider Demographics
NPI:1992949853
Name:BUCHHOLZ, KEITH LEE (DO)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LEE
Last Name:BUCHHOLZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10155 MANGROVE DR #105
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-8312
Mailing Address - Country:US
Mailing Address - Phone:954-643-1297
Mailing Address - Fax:
Practice Address - Street 1:10155 MANGROVE DR #105
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1001
Practice Address - Country:US
Practice Address - Phone:954-643-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11717207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine