Provider Demographics
NPI:1871636746
Name:HOLLAND, MARIUM GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIUM
Middle Name:GRACE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIUM
Other - Middle Name:HOLLAND
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-6200
Mailing Address - Fax:913-588-6271
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 2028
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7316
Practice Address - Country:US
Practice Address - Phone:713-500-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36471207V00000X, 207VM0101X
TXN0838207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199883301Medicaid
8F9686OtherBLUE CROSS BLUE SHIELD
8L8643Medicare PIN
073A00022Medicare PIN