Provider Demographics
NPI:1053375469
Name:HOLL, JANE LOUISE (MD MPH)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:HOLL
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 E CHICAGO AVE
Mailing Address - Street 2:ROOM 717
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-503-0392
Mailing Address - Fax:312-503-2936
Practice Address - Street 1:467 W DEMING ST
Practice Address - Street 2:LINCOLN PARK PRIMARY CARE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-327-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33219Medicare UPIN
ILL84658Medicare ID - Type Unspecified