Provider Demographics
NPI:1477684413
Name:HOLLY FOOT & ANKLE SPECIALISTS PLC
Entity type:Organization
Organization Name:HOLLY FOOT & ANKLE SPECIALISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-634-6200
Mailing Address - Street 1:4038 GRANGE HALL RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1160
Mailing Address - Country:US
Mailing Address - Phone:248-634-6200
Mailing Address - Fax:248-634-6213
Practice Address - Street 1:4038 GRANGE HALL RD
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1160
Practice Address - Country:US
Practice Address - Phone:248-634-6200
Practice Address - Fax:248-634-6213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLLY FOOT & ANKLE SPECIALISTS PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4810985Medicaid
MI480F327690OtherBCBS
MI1477684413OtherMEDICARE NGS
MIDE9901Medicare PIN
MI1477684413OtherMEDICARE NGS
MI480F327690OtherBCBS