Healthcare Provider Details

I. General information

NPI: 1821837709
Provider Name (Legal Business Name): KEVIN HOLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9630 GARFIELD
REDFORD MI
48239-2000
US

IV. Provider business mailing address

9630 GARFIELD
REDFORD MI
48239-2000
US

V. Phone/Fax

Practice location:
  • Phone: 313-588-5925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121481
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: