Basic Information
| Provider Information | |||||||||
| NPI: | 1568789147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1318 S FINLEY RD APT 2D | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601484339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304410906 | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 CARY HALL, 3435 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168292012 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2010 | ||||||||
| LastUpdateDate: | 11/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | P5992 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01200465 | 01 | TX | MEDICARE RAILROAD | OTHER | 320803501 | 05 | TX | MEDICAID |