Provider Demographics
NPI:1831189240
Name:HOLM, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:HOLM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-5000
Mailing Address - Fax:320-229-5184
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-5000
Practice Address - Fax:320-229-5184
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42193207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
863923OtherARAZ GROUP/AMERICA'S PPO
123826OtherU-CARE
2114050OtherFIRST HEALTH PLAN
74D33HOOtherBLUE CROSS BLUE SHIELD
1021425OtherPREFERRED ONE
3300079OtherMEDICA HEALTH PLANS
HP29634OtherHEALTH PARTNERS
509R1HOOtherBLUE CROSS BLUE SHIELD
215575300OtherMEDICAL ASSISTANCE (MA)
460002635OtherRR MEDICARE
509R1HOOtherBLUE CROSS BLUE SHIELD
74D33HOOtherBLUE CROSS BLUE SHIELD