Provider Demographics
NPI:1134434731
Name:HOLISTIC HEALTH REALITIES LLC
Entity type:Organization
Organization Name:HOLISTIC HEALTH REALITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRBISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-738-2742
Mailing Address - Street 1:7903 E 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8599
Mailing Address - Country:US
Mailing Address - Phone:219-738-2742
Mailing Address - Fax:219-947-5340
Practice Address - Street 1:111 W 10TH ST
Practice Address - Street 2:SUITE100
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5990
Practice Address - Country:US
Practice Address - Phone:219-738-2742
Practice Address - Fax:219-942-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN036103826207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty