Provider Demographics
NPI:1134191307
Name:HOLLIFIELD, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HOLLIFIELD
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 1:4710 JEFFERSON ST NE
Mailing Address - Street 2:JENNY CEBADA
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2155
Mailing Address - Country:US
Mailing Address - Phone:505-884-1114
Mailing Address - Fax:505-884-3004
Practice Address - Street 1:4710 JEFFERSON ST NE
Practice Address - Street 2:JENNY CEBADA
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2155
Practice Address - Country:US
Practice Address - Phone:505-884-1114
Practice Address - Fax:505-884-3004
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64091713Medicaid
KY0878424Medicare ID - Type Unspecified
KYF68402Medicare UPIN
KY64091713Medicaid