Provider Demographics
NPI:1760462089
Name:HOLSTON, KIRK S (DPM)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:S
Last Name:HOLSTON
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10332 POWER DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4759
Mailing Address - Country:US
Mailing Address - Phone:317-846-0515
Mailing Address - Fax:
Practice Address - Street 1:6002 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-5614
Practice Address - Country:US
Practice Address - Phone:317-880-6002
Practice Address - Fax:317-880-0417
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001328A208100000X
IN070000768A213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000364510OtherANTHEM BCBS
IN0005497063OtherAETNA
IN100121880AMedicaid
P00284245OtherRR MCR
IN202158547OtherTRICARE
IN100121880Medicaid
5392850001Medicare NSC
P00284245OtherRR MCR
IN210070CMedicare PIN
INU38614Medicare UPIN
IN100121880AMedicaid
5392850002Medicare NSC