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General NPI Number Information
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NPI Number | 1023076478
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Entity Type | Organization
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Legal Business Name | JO ANN M. HOLOKA, M.D.
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 461 N MULFORD RD, SUITE 5
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City | ROCKFORD
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State | IL
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Zip | 61107-5190
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Country | US
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Telephone | 815-397-8755
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Fax | 815-397-8916
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Provider Business Mailing Address
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Address Line | 461 N MULFORD RD, SUITE 5
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City | ROCKFORD
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State | IL
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Zip | 61107-5190
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Country | US
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Telephone | 815-397-8755
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Fax | 815-397-8916
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Authorized Official
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Title or Position | PRESIDENT
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Name | JO ANN M. HOLOKA
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Credential | M.D.
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Telephone | 815-397-8755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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