Provider Demographics
NPI:1831306612
Name:LOUD, HOLLY MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MARIE
Last Name:LOUD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:MARIE
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8409
Mailing Address - Country:US
Mailing Address - Phone:815-759-3100
Mailing Address - Fax:815-363-9094
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-759-3100
Practice Address - Fax:815-363-9094
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127057207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127057Medicaid
IL036127057Medicaid