Basic Information
| Provider Information | |||||||||
| NPI: | 1679667232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | DALILA | ||||||||
| MiddleName: | K. IRONS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| OtherLastName: | IRONS | ||||||||
| OtherFirstName: | DALILA | ||||||||
| OtherMiddleName: | K | ||||||||
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| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 701 LEE ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 500164545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473905477 | ||||||||
| FaxNumber: | 8473905922 | ||||||||
| Practice Location | |||||||||
| Address1: | 9550 W. 167TH ST. | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088734500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036111900 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 036111900 | 05 | IL | MEDICAID |