Provider Demographics
NPI:1497335236
Name:HOLLOWAY, EMMA DUTTON
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:DUTTON
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W HIGGINS RD STE 440
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2044
Mailing Address - Country:US
Mailing Address - Phone:847-839-0400
Mailing Address - Fax:
Practice Address - Street 1:2500 W HIGGINS RD STE 440
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2044
Practice Address - Country:US
Practice Address - Phone:847-839-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036169569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics