Provider Demographics
NPI:1588660658
Name:HOLASEK, MAUREEN CLAIRE (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CLAIRE
Last Name:HOLASEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 864460
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-0001
Mailing Address - Country:US
Mailing Address - Phone:352-243-9709
Mailing Address - Fax:352-243-8703
Practice Address - Street 1:1920 DON WICKHAM DR
Practice Address - Street 2:STE. 130
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1918
Practice Address - Country:US
Practice Address - Phone:352-243-9709
Practice Address - Fax:352-243-8703
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62103174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00470573OtherRR MEDICARE
FL15050OtherBCBS
FL212921OtherAVMED
FL370683400Medicaid
FL15050SMedicare PIN
FL15050UMedicare PIN
FL15050OtherBCBS
FL15050RMedicare PIN
FL370683400Medicaid
FL15050TMedicare PIN
FLP00470573OtherRR MEDICARE
FL15050PMedicare PIN
FL15050LMedicare PIN
FL15050GMedicare PIN
FL212921OtherAVMED
FL15050MMedicare PIN
FL15050OMedicare PIN
FL15050QMedicare PIN