Provider Demographics
NPI:1295769297
Name:HOLLER-MANAGAN, YOLANDA F (MD)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:F
Last Name:HOLLER-MANAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 N. WINFIELD ROAD
Mailing Address - Street 2:PEDIATRIC OUTPATIENT, EAST CLINIC
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:630-933-4954
Mailing Address - Fax:630-933-4225
Practice Address - Street 1:25 N. WINFIELD ROAD
Practice Address - Street 2:PEDIATRIC OUTPATIENT, EAST CLINIC
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-933-4954
Practice Address - Fax:630-933-4225
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1019442084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2405169Medicaid
OHHO7327731Medicare ID - Type Unspecified
I20149Medicare UPIN