Provider Demographics
NPI:1548452675
Name:HOLTZ, ANITA GREWAL (MD)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:GREWAL
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD STE 530
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8140
Mailing Address - Country:US
Mailing Address - Phone:214-778-1075
Mailing Address - Fax:214-778-1237
Practice Address - Street 1:6124 W PARKER RD STE 530
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8140
Practice Address - Country:US
Practice Address - Phone:214-778-1075
Practice Address - Fax:214-778-1237
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051595207R00000X
TXN6361207RP1001X, 390200000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324459201Medicaid
TX794600OtherWELLCARE ID
TX8DT440OtherBCBS
TXFH1639395OtherDEA