Provider Demographics
NPI:1831197557
Name:HOLEKAMP, NANCY (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HOLEKAMP
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 1:1815 CLARKSON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5065
Mailing Address - Country:US
Mailing Address - Phone:636-728-0111
Mailing Address - Fax:636-728-0093
Practice Address - Street 1:1815 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5065
Practice Address - Country:US
Practice Address - Phone:636-728-0111
Practice Address - Fax:636-728-0093
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206670309Medicaid
MO008012214Medicare ID - Type Unspecified
MO206670309Medicaid
ILL37401Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 099
ILL94646Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 012