Healthcare Provider Details

I. General information

NPI: 1699751735
Provider Name (Legal Business Name): ALISON S HOLLOWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON SENNELLO HOLLOWAY M.D.

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 NORTH RIVER ROAD, SUITE 100A
ROSEMONT IL
60018
US

IV. Provider business mailing address

1307 COUNTRYSIDE MANOR PL
CHESTERFIELD MO
63005
US

V. Phone/Fax

Practice location:
  • Phone: 312-421-1016
  • Fax: 847-787-7144
Mailing address:
  • Phone: 702-428-0094
  • Fax: 636-590-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38428-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-098167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: