Provider Demographics
NPI:1548297658
Name:CROMWELL, HOLLY HELEN (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:HELEN
Last Name:CROMWELL
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 1:3735 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4908
Mailing Address - Country:US
Mailing Address - Phone:847-556-7525
Mailing Address - Fax:847-556-7525
Practice Address - Street 1:645 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5015
Practice Address - Country:US
Practice Address - Phone:773-626-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099992207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099992Medicaid
IL036099992Medicaid
ILH75462Medicare UPIN