Individual
PATRICK M. HOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6404 ROTHMAN RD, FORT WAYNE, IN 46835-1366
(260) 486-6197
(260) 486-9862
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042777A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000206199
BLUE CROSS
—
05
—
200009260
—
IN
Enumeration date
06/21/2006
Last updated
10/01/2020
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