MEDICARE: ROGER HOLMAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101006733	MI
2	207P00000X	Emergency Medicine Physician	5101006733	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0N27520	OTHER	MI	MEDICARE MCUG GROUP
2	N27520004	OTHER	MI	MEDICARE MGUC INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	005703574	OTHER	MI	BCBSMI
4	0027003	OTHER	MI	PRIORITY HEALTH HMO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	P57675	OTHER	MI	BLUES HMO'S
7	RH006733	OTHER		BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073518270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER HOLMAN DO

Provider Business Mailing Address
First Line	:	675 W RANDALL ST
Second Line	:
City	:	COOPERSVILLE
State	:	MI
Zip	:	49404-1305
Country	:	US
Telephone Number	:	616-837-9777
Fax Number	:	616-837-7813

Provider Business Practice Location Address
First Line	:	675 W RANDALL ST
Second Line	:
City	:	COOPERSVILLE
State	:	MI
Zip	:	49404-1305
Country	:	US
Telephone Number	:	616-837-9777
Fax Number	:	616-837-7813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	12/13/2012

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Directions to “ ROGER HOLMAN DO” Practice Location

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