Provider Demographics
NPI:1053623330
Name:HOLSCHBACH, JUSTIN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:HOLSCHBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:308 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3506
Mailing Address - Country:US
Mailing Address - Phone:309-663-5050
Mailing Address - Fax:309-662-3401
Practice Address - Street 1:308 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3506
Practice Address - Country:US
Practice Address - Phone:309-663-5050
Practice Address - Fax:309-662-3401
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.132875207Q00000X
MO2012030856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine