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1760462089

NPI Code Detail

MEDICARE: KIRK S HOLSTON DPM

MEDICARE: KIRK S HOLSTON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	05001328A	IN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	070000768A	IN
3	213E00000X	Podiatrist	070000768A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0005497063	OTHER	IN	AETNA
3	000000364510	OTHER	IN	ANTHEM BCBS
4	P00284245	OTHER		RR MCR
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	202158547	OTHER	IN	TRICARE

General Provider Information

NPI Number	:	1760462089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK S HOLSTON DPM

Provider Business Mailing Address
First Line	:	PO BOX 637764
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-7764
Country	:	US
Telephone Number	:	317-880-3939
Fax Number	:

Provider Business Practice Location Address
First Line	:	6002 E 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-5614
Country	:	US
Telephone Number	:	317-880-6002
Fax Number	:	317-880-0417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	09/22/2025

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Directions to “ KIRK S HOLSTON DPM” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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