Provider Demographics
NPI:1689660920
Name:HOLICKI, JOSEPH PETER (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:HOLICKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-8423
Mailing Address - Country:US
Mailing Address - Phone:517-279-7927
Mailing Address - Fax:517-278-3393
Practice Address - Street 1:142 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8423
Practice Address - Country:US
Practice Address - Phone:517-279-7927
Practice Address - Fax:517-278-3393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010943207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3519504Medicaid
MIM60710002Medicare ID - Type Unspecified
MI3519504Medicaid
IN163680Medicare ID - Type Unspecified