Healthcare Provider Details

I. General information

NPI: 1003848094
Provider Name (Legal Business Name): DAVID MICHAEL HOLAJTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MULBERRY ST
EVANSVILLE IN
47713-1230
US

IV. Provider business mailing address

2015 MAXWELL AVE
EVANSVILLE IN
47711
US

V. Phone/Fax

Practice location:
  • Phone: 812-423-7791
  • Fax: 812-436-4316
Mailing address:
  • Phone: 812-422-7974
  • Fax: 812-422-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01027780A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: