Provider Demographics
NPI:1891707451
Name:HOLIFIELD, MARSHALL I (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:I
Last Name:HOLIFIELD
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:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-0820
Mailing Address - Country:US
Mailing Address - Phone:605-940-7583
Mailing Address - Fax:712-478-4086
Practice Address - Street 1:1305 W 18TH ST # 6729
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-1000
Practice Address - Fax:712-478-4086
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD60601207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN458697000Medicaid
MN050001978Medicare ID - Type Unspecified
MN458697000Medicaid
MN050002099Medicare PIN