Provider Demographics
NPI:1881782712
Name:HOLTAN, NEAL ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:ROSS
Last Name:HOLTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:500 E GRANT ST
Mailing Address - Street 2:APARTMENT 2310
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1421
Mailing Address - Country:US
Mailing Address - Phone:612-375-0323
Mailing Address - Fax:612-317-0713
Practice Address - Street 1:500 E GRANT ST
Practice Address - Street 2:APARTMENT 2310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1421
Practice Address - Country:US
Practice Address - Phone:612-375-0323
Practice Address - Fax:612-317-0713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN219422083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21942OtherLICENSE
MN21942OtherLICENSE
MN21942OtherLICENSE