Provider Demographics
NPI:1851320717
Name:HOLBERT, PATRICK W (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
Last Name:HOLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5515 CLEVELAND AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9670
Mailing Address - Country:US
Mailing Address - Phone:269-429-9644
Mailing Address - Fax:269-429-4002
Practice Address - Street 1:5515 CLEVELAND AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9670
Practice Address - Country:US
Practice Address - Phone:269-429-9644
Practice Address - Fax:269-429-4002
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104707895Medicaid
MI104700203Medicaid
MIPH047960OtherBLUE SHIELD
MI104707895Medicaid
MIM60660296Medicare PIN