Provider Demographics
NPI:1033313747
Name:HOLUBAR, STEFAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:DAVID
Last Name:HOLUBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-8578
Mailing Address - Fax:216-445-8627
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1000
Practice Address - Country:US
Practice Address - Phone:216-445-8578
Practice Address - Fax:216-445-8627
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50003208C00000X
OH35.131752208C00000X
NH14924208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017927Medicaid
NH30209776Medicaid
MN833120000Medicaid
NH30209776Medicaid
MN280000124Medicare PIN