Healthcare Provider Details

I. General information

NPI: 1083048136
Provider Name (Legal Business Name): MARGARET HOLLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAGGIE HOLLY

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5758 S MARYLAND AVE DCAM 5824
CHICAGO IL
60637-1426
US

IV. Provider business mailing address

9218 WALNUT LN
TINLEY PARK IL
60487-5252
US

V. Phone/Fax

Practice location:
  • Phone: 773-834-7081
  • Fax:
Mailing address:
  • Phone: 708-256-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: