Provider Demographics
NPI:1851462436
Name:J MICHAEL HOLDER DO LTD
Entity Type:Organization
Organization Name:J MICHAEL HOLDER DO LTD
Other - Org Name:JAN D ZIEREN DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-866-8603
Mailing Address - Street 1:720 EAST THUNDERBIRD RD
Mailing Address - Street 2:STE 3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022
Mailing Address - Country:US
Mailing Address - Phone:602-866-8603
Mailing Address - Fax:602-866-2413
Practice Address - Street 1:720 EAST THUNDERBIRD RD
Practice Address - Street 2:STE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-866-8603
Practice Address - Fax:602-866-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1437207Q00000X
AZ1777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCMBR02Medicare ID - Type Unspecified
E84585Medicare UPIN
D47209Medicare UPIN
AZZWCMBR01Medicare ID - Type Unspecified