Healthcare Provider Details

I. General information

NPI: 1508821034
Provider Name (Legal Business Name): MARTIN S HOLMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 B DR N
ALBION MI
49224-8420
US

IV. Provider business mailing address

300 B DR N
ALBION MI
49224-8420
US

V. Phone/Fax

Practice location:
  • Phone: 517-629-2134
  • Fax: 517-629-7953
Mailing address:
  • Phone: 517-629-2134
  • Fax: 517-629-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301069035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: