Provider Demographics
NPI:1023076478
Name:JO ANN M. HOLOKA, M.D.
Entity type:Organization
Organization Name:JO ANN M. HOLOKA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-397-8755
Mailing Address - Street 1:461 N MULFORD RD, SUITE 5
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5190
Mailing Address - Country:US
Mailing Address - Phone:815-397-8755
Mailing Address - Fax:815-397-8916
Practice Address - Street 1:461 N MULFORD RD, SUITE 5
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5190
Practice Address - Country:US
Practice Address - Phone:815-397-8755
Practice Address - Fax:815-397-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16373Medicare UPIN