Healthcare Provider Details

I. General information

NPI: 1689660920
Provider Name (Legal Business Name): JOSEPH PETER HOLICKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E CHICAGO RD
COLDWATER MI
49036-8423
US

IV. Provider business mailing address

142 E CHICAGO RD
COLDWATER MI
49036-8423
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-7927
  • Fax: 517-278-3393
Mailing address:
  • Phone: 517-279-7927
  • Fax: 517-278-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5101010943
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: