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NPI Code Detail

MEDICARE: DR. ASHLEY EASTON HOLDRIDGE D.O.

MEDICARE: DR. ASHLEY EASTON HOLDRIDGE D.O.
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
12084N0400XNeurology Physician036.135443IL
22084N0400XNeurology Physician63981WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790003549
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ASHLEY EASTON HOLDRIDGE D.O.
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 325 E SILVER SPRING DR
Second Line :
City : WHITEFISH BAY
State : WI
Zip : 53217-5222
Country : US
Telephone Number : 414-247-4800
Fax Number : 414-247-4801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2010
Last Update Date : 07/22/2024

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