MEDICARE: MICHAEL C. HOLMES, MD, PLLC

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	208000000X	Pediatrics Physician

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

General Provider Information

NPI Number	:	1689132540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL C. HOLMES, MD, PLLC

Provider Business Mailing Address
First Line	:	1464 E WHITESTONE BLVD STE 2104
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9079
Country	:	US
Telephone Number	:	512-260-8100
Fax Number	:	512-260-8103

Provider Business Practice Location Address
First Line	:	1464 E WHITESTONE BLVD STE 2104
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9079
Country	:	US
Telephone Number	:	512-260-8100
Fax Number	:	512-260-8103

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	MICHAEL HOLMES
Credential	:	MD
Telephone Number	:	504-813-7701

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	03/08/2019

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