Provider Demographics
NPI:1336161629
Name:HOLMES, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1415 SALEM ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2099
Mailing Address - Country:US
Mailing Address - Phone:765-449-2410
Mailing Address - Fax:765-742-8607
Practice Address - Street 1:3920 ST FRANCIS WAY
Practice Address - Street 2:SUITE 209
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4917
Practice Address - Country:US
Practice Address - Phone:765-775-2860
Practice Address - Fax:765-775-2826
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100232090Medicaid
INP00175931Medicare PIN
IN100232090Medicaid
IN220170GMedicare PIN