Provider Demographics
NPI:1821217977
Name:HOLYK, PETER ROMAN (MD CNS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROMAN
Last Name:HOLYK
Suffix:
Gender:M
Credentials:MD CNS
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Mailing Address - Street 1:680 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4836
Mailing Address - Country:US
Mailing Address - Phone:772-388-1222
Mailing Address - Fax:772-589-1282
Practice Address - Street 1:1345 36TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4811
Practice Address - Country:US
Practice Address - Phone:772-567-1500
Practice Address - Fax:772-567-1505
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2012-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME515452083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC84558Medicare UPIN