Healthcare Provider Details

I. General information

NPI: 1316121155
Provider Name (Legal Business Name): MS. ANITA C HOLUBIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 S MAPLEWOOD AVE
CHICAGO IL
60655-1525
US

IV. Provider business mailing address

11825 S MAPLEWOOD AVE
CHICAGO IL
60655-1525
US

V. Phone/Fax

Practice location:
  • Phone: 773-239-4855
  • Fax: 773-239-7505
Mailing address:
  • Phone: 773-239-4855
  • Fax: 773-239-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: