Basic Information
| Provider Information | |||||||||
| NPI: | 1851736656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLIFIELD | ||||||||
| FirstName: | LAKISHA | ||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | MARSHALL | ||||||||
| OtherFirstName: | LAKISHA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2006 HOGBACK ROAD STE 5A | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347862317 | ||||||||
| FaxNumber: | 7347864977 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349364280 | ||||||||
| FaxNumber: | 7349369091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2013 | ||||||||
| LastUpdateDate: | 07/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 4301103165 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.