Provider Demographics
NPI:1730162876
Name:HOELDTKE, NATHAN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOHN
Last Name:HOELDTKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 STORNAWAY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7576
Mailing Address - Country:US
Mailing Address - Phone:731-541-6939
Mailing Address - Fax:731-541-4570
Practice Address - Street 1:620 SKYLINE DR
Practice Address - Street 2:MID-SOUTH PERINATAL ASSOCIATES
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3923
Practice Address - Country:US
Practice Address - Phone:731-541-6939
Practice Address - Fax:731-541-4570
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000037448207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4138631OtherBCBS
TN3830255Medicaid
MS00074891Medicaid
TN3830255Medicaid