Healthcare Provider Details

I. General information

NPI: 1508105842
Provider Name (Legal Business Name): STEPHEN R. HOLUK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 MAIN ST.
THREE RIVERS MA
01080
US

IV. Provider business mailing address

2175 MAIN ST.
THREE RIVERS MA
01080
US

V. Phone/Fax

Practice location:
  • Phone: 413-283-7171
  • Fax: 413-283-7171
Mailing address:
  • Phone: 413-283-7171
  • Fax: 413-283-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number48798
License Number StateMA

VIII. Authorized Official

Name: STEPHEN R HOLUK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 413-283-7171