Provider Demographics
NPI:1699140814
Name:HOLGADO, THADDEUS (CO)
Entity type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:
Last Name:HOLGADO
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E. BUTTERFIELD ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-627-5383
Mailing Address - Fax:
Practice Address - Street 1:12075 CORPORATE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-2665
Practice Address - Country:US
Practice Address - Phone:844-447-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000212222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist