Provider Demographics
NPI:1053343608
Name:HOLLADAY, THERESA MARIE BARTOS (DO)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE BARTOS
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:506 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1050
Mailing Address - Fax:906-483-1270
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:STE 3
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1050
Practice Address - Fax:906-483-1270
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITB 010618207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology