Provider Demographics
NPI:1265242200
Name:HOLMES, DONNELL JR
Entity type:Individual
Prefix:
First Name:DONNELL
Middle Name:
Last Name:HOLMES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15323 NORTHGATE BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3322
Mailing Address - Country:US
Mailing Address - Phone:313-765-5510
Mailing Address - Fax:
Practice Address - Street 1:15323 NORTHGATE BLVD APT 201
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3322
Practice Address - Country:US
Practice Address - Phone:313-765-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker