Provider Demographics
NPI:1255431524
Name:HOLSINGER, JILL RP (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RP
Last Name:HOLSINGER
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 1:400 EAST 3RD STREET
Mailing Address - Street 2:SMDC MEDICAL CENTER-DULUTH CLINIC
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805
Mailing Address - Country:US
Mailing Address - Phone:218-786-8160
Mailing Address - Fax:
Practice Address - Street 1:400 EAST 3RD STREET
Practice Address - Street 2:SMDC MEDICAL CENTER-DULUTH CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-786-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN515892085R0202X
WI402232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1255431524Medicaid
WI1255431524Medicaid
I08077Medicare UPIN
MN300005143Medicare PIN