Healthcare Provider Details

I. General information

NPI: 1528590577
Provider Name (Legal Business Name): HOLLY D STORM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY D KOFELDT DO

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 NAAB RD SUITE 210
INDIANAPOLIS IN
46260-1972
US

IV. Provider business mailing address

395 WESTFIELD RD STE B
NOBLESVILLE IN
46060-1425
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7510
  • Fax: 317-338-7540
Mailing address:
  • Phone: 317-773-0760
  • Fax: 317-776-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02006320A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: