Provider Demographics
NPI:1700860806
Name:HOLM, LYDIA J (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:J
Last Name:HOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:J
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 PLEASANT ST
Mailing Address - Street 2:PEDIATRIC EMERGENCY DEPARTMENT
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-6611
Mailing Address - Fax:515-241-6635
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:BLANK ADMINISTRATION
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-5926
Practice Address - Fax:515-241-5127
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-357722080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1700860806Medicaid
MN1700860806Medicaid
NE100264995-00Medicaid
NE100264995-00Medicaid