Healthcare Provider Details

I. General information

NPI: 1174562599
Provider Name (Legal Business Name): KEITH R HOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 STATE RD
CUYAHOGA FALLS OH
44223-3614
US

IV. Provider business mailing address

PO BOX 609
CUYAHOGA FALLS OH
44222-0609
US

V. Phone/Fax

Practice location:
  • Phone: 330-945-4739
  • Fax: 330-945-7381
Mailing address:
  • Phone: 330-923-6606
  • Fax: 330-923-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35043324H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: