Provider Demographics
NPI:1235107632
Name:HOLIBAUGH, SUSAN E (DPM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:HOLIBAUGH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1846
Mailing Address - Country:US
Mailing Address - Phone:231-733-1511
Mailing Address - Fax:231-489-7500
Practice Address - Street 1:1281 E SHERMAN BLVD
Practice Address - Street 2:1281 E SHERMAN
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-733-1511
Practice Address - Fax:231-733-7980
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001528213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4609590001OtherADMINASTAR DMERC
MI4856110470OtherBCBSM
MI2693057Medicaid
MIOM49420Medicare ID - Type Unspecified
MIU11009Medicare UPIN
MI2693057Medicaid
MI4856110470OtherBCBSM