MEDICARE: IRIS HOLMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085-010154	IL

General Provider Information

NPI Number	:	1558083600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS HOLMAN

Provider Business Mailing Address
First Line	:	555 31ST ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 N JANSSEN AVE UNIT G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5168
Country	:	US
Telephone Number	:	651-808-7525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	03/27/2024

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Directions to “ IRIS HOLMAN ” Practice Location

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