Provider Demographics
NPI:1578188348
Name:HOLMES, DEREK J
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:J
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 W CAPITOL DR STE 8
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1335
Mailing Address - Country:US
Mailing Address - Phone:414-207-1852
Mailing Address - Fax:877-421-9343
Practice Address - Street 1:10111 W CAPITOL DR STE 8
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1335
Practice Address - Country:US
Practice Address - Phone:414-207-1852
Practice Address - Fax:877-421-9343
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health