Derrick Holeman, MD
Individual provider Active NPI Pediatrics Physician · Walker, MI
NPI 1821385683 · NPPES record last updated Jun 12, 2014
Key facts
- NPI
- 1821385683
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 4301099213 (MI)
- Practice address
- 4288 3 Mile Rd NW
Walker, MI 49534-7596 - Phone
- (616) 458-3677
- Fax
- (616) 459-6850
- NPI assigned
- Jun 30, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140122001851 | MI | Order and Referring Only - Pediatric Medicine |
2567690423 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301099213 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abc Pediatrics, PC | Pediatrics | Current | Accepting new patients |
Locations
4288 3 Mile Rd NW
Walker, MI 49534
Phone (616) 458-3677
Interoperability endpoints
- derrickholeman@abcp.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301099213 | MI | Yes |
Addresses
Primary practice location
4288 3 Mile Rd NW
Walker, MI 49534-7596
Mailing address
4288 3 Mile Rd NW
Walker, MI 49534-7596
Phone (616) 458-3677
Other providers in Walker, MI
- Lindsey Elie Heathman
- Zachary D Heathman
- Elinore Louise Hegedus
- Yoselin Hertz
- David G Higley
- Jeffrey Phillip Hollander
- Jeffrey Hoogstra
- Madelin House
- Jennifer Renee Hudson
- Huffman Counseling Services
All providers in Walker, MI · Pediatrics Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.