Provider Demographics
NPI:1386649226
Name:HOLZUM, DONNA J (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:HOLZUM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-386-7679
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:SJMMC DEPT OF ANES
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:636-386-9224
Practice Address - Fax:636-386-7679
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-10-30
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Provider Licenses
StateLicense IDTaxonomies
MOR3J96207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE64646Medicare UPIN