Provider Demographics
NPI:1063483295
Name:HOLBERG, STEVEN ERIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ERIC
Last Name:HOLBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 MASON CORBIN CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7738
Mailing Address - Country:US
Mailing Address - Phone:239-936-5400
Mailing Address - Fax:239-936-9572
Practice Address - Street 1:5238 MASON CORBIN CT
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7738
Practice Address - Country:US
Practice Address - Phone:239-936-5400
Practice Address - Fax:239-936-9572
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001138213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041103500Medicaid
FL87612Medicare ID - Type Unspecified
FL041103500Medicaid
FLY55471Medicare UPIN