Provider Demographics
NPI:1215103494
Name:HOLM, MICHELLE JOY (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOY
Last Name:HOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5947
Mailing Address - Country:US
Mailing Address - Phone:800-336-8614
Mailing Address - Fax:
Practice Address - Street 1:34515 9TH AVE S
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6761
Practice Address - Country:US
Practice Address - Phone:253-944-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60070611207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8542367Medicaid
WA0250402OtherLIWA
WA0251022OtherVCR
WAP00744105OtherRRGA
WA1032HOOtherBSWA
WA0251022OtherLIWA
WA1029HOOtherBSWA
MN19577OtherRESIDENT PERMIT
WA0250402OtherVCR
WA1032HOOtherBSWA