Provider Demographics
NPI:1659948545
Name:HOLT, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:HOLT
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 1:9864 E GRAND RIVER AVE STE 110-106
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1963
Mailing Address - Country:US
Mailing Address - Phone:248-214-3988
Mailing Address - Fax:
Practice Address - Street 1:9864 E GRAND RIVER AVE STE 110-106
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1963
Practice Address - Country:US
Practice Address - Phone:248-214-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5803001670343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)