MEDICARE: MICHAEL HOLLAND DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	MH400209	MI

General Provider Information

NPI Number	:	1881617686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HOLLAND DPM

Provider Business Mailing Address
First Line	:	3601 WILDER RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2113
Country	:	US
Telephone Number	:	989-667-3668
Fax Number	:	989-667-3670

Provider Business Practice Location Address
First Line	:	3601 WILDER RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2113
Country	:	US
Telephone Number	:	989-667-3668
Fax Number	:	989-667-3670

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/01/2007

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