# MICHAEL A HOLY A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MICHAEL A HOLY MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790726693
- **Authorized official:** MICHAEL ADRIAN HOLY M.D. (PRESIDENT)
- **Authorized official phone:** (318) 424-1617

## Contact information

- **Practice address:** 1801 FAIRFIELD AVE, SUITE 101, SHREVEPORT, LA 71101-4443
- **Practice address phone:** (318) 424-1617
- **Practice address fax:** (318) 424-1610
- **Mailing address:** 1801 FAIRFIELD AVE, SUITE 101, SHREVEPORT, LA 71101-4443
- **Mailing address phone:** (318) 424-1617
- **Mailing address fax:** (318) 424-1610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 03517R | LA | Yes |

## Other

- **Enumeration date:** 06/09/2006
- **Last updated:** 02/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1142239 | — | LA |