Provider Demographics
NPI:1215963210
Name:HOLT, ANGELA MICHELE (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:HOLT
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 1:1900 S MAIN ST
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1214
Mailing Address - Country:US
Mailing Address - Phone:419-358-9010
Mailing Address - Fax:419-358-1532
Practice Address - Street 1:139 GARAU ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1027
Practice Address - Country:US
Practice Address - Phone:419-358-9010
Practice Address - Fax:419-358-1532
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055972174400000X
OH35069880207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3102216Medicaid
OH7324202Medicare PIN