Provider Demographics
NPI:1831452036
Name:HOLDREN OTIS, ERIN (DPM)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HOLDREN OTIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14229 TORREY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3308
Mailing Address - Country:US
Mailing Address - Phone:810-629-3338
Mailing Address - Fax:810-629-9243
Practice Address - Street 1:14229 TORREY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3308
Practice Address - Country:US
Practice Address - Phone:810-629-3338
Practice Address - Fax:810-629-9243
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002450213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist