Healthcare Provider Details

I. General information

NPI: 1548559867
Provider Name (Legal Business Name): MICHAEL HOLMOE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 22ND AVE
BROOKINGS SD
57006-2474
US

IV. Provider business mailing address

310 22ND AVE
BROOKINGS SD
57006-2474
US

V. Phone/Fax

Practice location:
  • Phone: 605-696-2700
  • Fax:
Mailing address:
  • Phone: 605-696-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11285
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: