Healthcare Provider Details

I. General information

NPI: 1366543902
Provider Name (Legal Business Name): GRADY MICHAEL HOLDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL HOLDER MD

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 RALSTON RD SUITE 100G
ARVADA CO
80004-4551
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80113-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-431-0844
  • Fax: 303-456-6124
Mailing address:
  • Phone: 303-360-6276
  • Fax: 303-467-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0028219
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: