Healthcare Provider Details

I. General information

NPI: 1235166364
Provider Name (Legal Business Name): MICHELLE MARIE HOLLOWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE WARE MD

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 SW 59TH STREET
OKLAHOMA CITY OK
73159-7024
US

IV. Provider business mailing address

1000 N LEE AVE BEHAVIORAL MEDICINE
OKLAHOMA CITY OK
73102-1036
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-6391
  • Fax: 405-713-4859
Mailing address:
  • Phone: 405-272-6216
  • Fax: 405-272-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number18507
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: