Provider Demographics
NPI:1760400147
Name:HOLTEBECK, AARON C (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:C
Last Name:HOLTEBECK
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 1:18200 W CAPITOL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1445
Mailing Address - Country:US
Mailing Address - Phone:262-393-2020
Mailing Address - Fax:414-377-4150
Practice Address - Street 1:18200 W CAPITOL DR STE 103
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-1445
Practice Address - Country:US
Practice Address - Phone:262-393-2020
Practice Address - Fax:414-377-4150
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49474207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34710600Medicaid
WI34710600Medicaid