Provider Demographics
NPI:1487687935
Name:HOLTE, DEBORAH AK (DPM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:AK
Last Name:HOLTE
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501
Mailing Address - Country:US
Mailing Address - Phone:660-665-9000
Mailing Address - Fax:660-665-8445
Practice Address - Street 1:1405 CROWN DRIVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-665-9000
Practice Address - Fax:660-665-8445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000684213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO306652512Medicaid
U37717Medicare UPIN
MO0534440001Medicare NSC
MO990001494Medicare PIN