Provider Demographics
NPI:1851407167
Name:SPECH-HOLDERBAUM, MICHELLE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:SPECH-HOLDERBAUM
Suffix:
Gender:F
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:PO BOX 781389
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1389
Mailing Address - Country:US
Mailing Address - Phone:440-354-1985
Mailing Address - Fax:440-350-4938
Practice Address - Street 1:36100 EUCLID AVE
Practice Address - Street 2:#240
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-953-6294
Practice Address - Fax:440-918-4687
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0756945Medicaid
OH0756945Medicaid
E29099Medicare UPIN