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General NPI Number Information
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NPI Number | 1548285612
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Entity Type | Individual
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Provider Name | HOLLY MAE MAES MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 737 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4363
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Country | US
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Telephone | 217-442-0433
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Fax | 217-442-0485
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Provider Business Mailing Address
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Address Line | 737 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4363
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Country | US
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Telephone | 217-442-0433
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Fax | 217-442-0485
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036-113601
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036113601
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License Number State | IL
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