Basic Information
| Provider Information | |||||||||
| NPI: | 1215963210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLT | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 S MAIN ST | ||||||||
| Address2: | MANAGED CARE DEPT | ||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193589010 | ||||||||
| FaxNumber: | 4193581532 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 GARAU ST | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458171027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193589010 | ||||||||
| FaxNumber: | 4193581532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301055972 | MI | N | Other Service Providers | Specialist | 207L00000X | 35069880 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3102216 | 05 | OH | MEDICAID |