Provider Demographics
NPI:1386609667
Name:HOLMES, MICHAEL JOSEPH (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5104
Mailing Address - Country:US
Mailing Address - Phone:585-342-5694
Mailing Address - Fax:585-342-2345
Practice Address - Street 1:1700 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-5104
Practice Address - Country:US
Practice Address - Phone:585-342-5694
Practice Address - Fax:585-342-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics