Healthcare Provider Details

I. General information

NPI: 1235107632
Provider Name (Legal Business Name): SUSAN E HOLIBAUGH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 E SHERMAN BLVD 1281 E SHERMAN
MUSKEGON MI
49444
US

IV. Provider business mailing address

1281 E SHERMAN BLVD
NORTON SHORES MI
49444-1846
US

V. Phone/Fax

Practice location:
  • Phone: 231-733-1511
  • Fax: 231-733-7980
Mailing address:
  • Phone: 231-733-1511
  • Fax: 231-489-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001528
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: