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General NPI Number Information
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NPI Number | 1649494717
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Entity Type | Individual
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Provider Name | MR. NORMAN C HOLTON
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 18263 E 10 MILE RD
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City | ROSEVILLE
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State | MI
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Zip | 48066-5805
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Country | US
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Telephone | 586-778-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 22454 RIO VISTA ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-2431
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Country | US
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Telephone | 586-772-8296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601001192
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License Number State | MI
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