Healthcare Provider Details

I. General information

NPI: 1174500524
Provider Name (Legal Business Name): MICHAEL CHARLES HOLUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231-4426
US

IV. Provider business mailing address

13601 PRESTON RD SUITE 900W
DALLAS TX
75240-4911
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-6148
  • Fax: 214-345-4322
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-386-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberJ8583
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: