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NPI Code Detail

MEDICARE: KURT STEVEN HOLST PA-C

MEDICARE: KURT STEVEN HOLST PA-C
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
1363A00000XPhysician Assistant739023WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27390-023OTHERWISTATE LICENSE

General Provider Information

NPI Number : 1467489047
Entity Type Code : Individual
Provider Name (Legal Business Name) : KURT STEVEN HOLST PA-C
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-663-9008
Fax Number : 920-684-1439
Provider Business Practice Location Address
First Line : 2806 RIVERVIEW DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54313-6717
Country : US
Telephone Number : 920-498-7546
Fax Number : 920-569-4129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 05/14/2025

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