Provider Demographics
NPI:1528132412
Name:HOLEC, SIDNEY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:WAYNE
Last Name:HOLEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 NOKOMIS AVE S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2617
Mailing Address - Country:US
Mailing Address - Phone:941-488-7742
Mailing Address - Fax:941-484-7756
Practice Address - Street 1:436 NOKOMIS AVE S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2617
Practice Address - Country:US
Practice Address - Phone:941-488-7742
Practice Address - Fax:941-484-7756
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022788208600000X
TXEO982208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92415OtherBCBS
FL04889OtherUNIVERSAL
FL7007140OtherCIGNA
FL020012689OtherRAILROAD MEDICARE
FL303424OtherUNITED HEALTH CARE GROUP MPIN
FL59-1362995OtherGROUP TAX ID #
FL92415OtherBCBS
FL303424OtherUNITED HEALTH CARE GROUP MPIN
FL92415ZMedicare ID - Type Unspecified