Provider Demographics
NPI:1912992504
Name:HOLTMAN, JUDY H (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:H
Last Name:HOLTMAN
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:DEPT 8093
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-8093
Mailing Address - Country:US
Mailing Address - Phone:866-286-9915
Mailing Address - Fax:502-471-2051
Practice Address - Street 1:444 S 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1416
Practice Address - Country:US
Practice Address - Phone:502-583-6647
Practice Address - Fax:502-585-4824
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18578207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY070006422OtherRAILROAD MEDICARE
KY000000053352OtherANTHEM PIN
KY1567601Medicare ID - Type Unspecified
KYC 72385Medicare UPIN