Provider Demographics
NPI:1467670901
Name:HOLROYD, THEODORE VOSS (PA)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:VOSS
Last Name:HOLROYD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-3107
Mailing Address - Country:US
Mailing Address - Phone:847-395-3322
Mailing Address - Fax:847-395-0921
Practice Address - Street 1:543 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-3107
Practice Address - Country:US
Practice Address - Phone:847-395-3322
Practice Address - Fax:847-395-0921
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant