MEDICARE: SHELLY WELCH HOLMSTROM MD

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	207V00000X	Obstetrics & Gynecology Physician	ME90448	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	48546	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427061043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY WELCH HOLMSTROM MD

Provider Business Mailing Address
First Line	:	1410 HARBOUR WALK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5971
Country	:	US
Telephone Number	:	813-394-1668
Fax Number	:

Provider Business Practice Location Address
First Line	:	4503 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6201
Country	:	US
Telephone Number	:	813-738-6684
Fax Number	:	813-413-8549

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	10/25/2023

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