Provider Demographics
NPI:1689132540
Name:MICHAEL C. HOLMES, MD, PLLC
Entity Type:Organization
Organization Name:MICHAEL C. HOLMES, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-813-7701
Mailing Address - Street 1:1464 E WHITESTONE BLVD STE 2104
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9079
Mailing Address - Country:US
Mailing Address - Phone:512-260-8100
Mailing Address - Fax:512-260-8103
Practice Address - Street 1:1464 E WHITESTONE BLVD STE 2104
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9079
Practice Address - Country:US
Practice Address - Phone:512-260-8100
Practice Address - Fax:512-260-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206844703Medicaid