Provider Demographics
NPI:1124378625
Name:HOLISTIC FAMILY MEDICINE
Entity Type:Organization
Organization Name:HOLISTIC FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MIKSCHAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHANISON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-642-1759
Mailing Address - Street 1:18931 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2298
Mailing Address - Country:US
Mailing Address - Phone:301-642-1759
Mailing Address - Fax:
Practice Address - Street 1:18931 FISHER AVE
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2298
Practice Address - Country:US
Practice Address - Phone:301-642-1759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01729171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty