Individual
TODD JERAMIE HOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
155 RADIO DR, WOODBURY, MN 55125-2619
(952) 831-8742
(952) 977-3459
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9820
MN
363AS0400X
Surgical Physician Assistant
1684
WI
363AS0400X
Surgical Physician Assistant
9820
MN
Other
Enumeration date
06/30/2005
Last updated
06/30/2023
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