Provider Demographics
NPI:1083709166
Name:HOLLOWAY, PHILIP (DPM)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 E COURT STREET
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2460
Mailing Address - Country:US
Mailing Address - Phone:217-465-8411
Mailing Address - Fax:217-465-3184
Practice Address - Street 1:727 E COURT STREET
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2460
Practice Address - Country:US
Practice Address - Phone:217-465-8411
Practice Address - Fax:217-465-3184
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003369213E00000X
IN07000548A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT35113Medicare UPIN
INT35113Medicare UPIN
IN252710AMedicare PIN
ILK34222Medicare PIN