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NPI Code Detail

MEDICARE: THOMAS J. HOLT MD

MEDICARE: THOMAS J. HOLT 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
1207Q00000XFamily Medicine Physician33544MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740240688
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS J. HOLT MD
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1400 JEFFERSON RD
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-3081
Country : US
Telephone Number : 507-663-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 10/18/2011

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