Provider Demographics
NPI:1588615660
Name:HOLLOWAY, MILTON G (MD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:G
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 NORKO DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3027
Mailing Address - Country:US
Mailing Address - Phone:810-733-0400
Mailing Address - Fax:810-733-8638
Practice Address - Street 1:5205 NORKO DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3027
Practice Address - Country:US
Practice Address - Phone:810-733-0400
Practice Address - Fax:810-733-8638
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH051513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC3740OtherMCARE
MI1001811OtherMCLAREN HEALTH PLAN
MIP79625OtherBCN INDIVIDUAL NUMBER
MI35025009012OtherBLUE CROSS BLUE SHIELD
MI3502500912OtherHEALTH PLUS
MI722-1OtherTOTAL HEALTH CARE
MI2964982Medicaid
MIG01761OtherBCN GROUP NUMBER
MIS14445OtherBCN SITE NUMBER
MI135980OtherPREFERRED CHOICES PPO
MI2074038OtherUNITED HEALTH CARE