Russell, Holly
Russell, Holly is an individual health care provider with primary practice located at 18210 La Grange Rd Suite 205, Tinley Park IL 60487-7722. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Russell, Holly can be contacted via phone (708) 478-7800.Contact Information
Primary practice address
18210 La Grange Rd Suite 205
Tinley Park IL 60487-7722
Phone: (708) 478-7800
Fax: (708) 478-7870
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | 2005017735 | Missouri |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 036120579 | Illinois |
Profile Details
| NPI number | 1174727267 |
|---|---|
| LBN Legal business name | Russell, Holly |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2007 |
| Last updated | Feb 23rd, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174727267 | NPPES |
| Illinois | MEDICAID | 036120579 |
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