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General NPI Number Information
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NPI Number | 1982019345
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Entity Type | Individual
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Provider Name | IRA JANHAVI HOLLA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 901 E MOUNT HOPE AVE
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City | LANSING
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State | MI
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Zip | 48910-3207
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Country | US
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Telephone | 517-267-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST CBO SUITE 4200
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-6426
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Fax | 601-815-0434
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 27617
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License Number State | MS
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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 | 4301105296
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License Number State | MI
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