Basic Information
| Provider Information | |||||||||
| NPI: | 1912941246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RETHOLTZ | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | TODD | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4235 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194795327 | ||||||||
| FaxNumber: | 4194795593 | ||||||||
| Practice Location | |||||||||
| Address1: | 5901 MONCLOVA RD | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198876754 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34-008582 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 34008582 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2639050 | 05 | OH | MEDICAID |