Provider Demographics
NPI:1699751735
Name:HOLLOWAY, ALISON S (MD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:S
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:SENNELLO
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1307 COUNTRYSIDE MANOR PL
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005
Mailing Address - Country:US
Mailing Address - Phone:702-428-0094
Mailing Address - Fax:636-590-1415
Practice Address - Street 1:6300 NORTH RIVER ROAD, SUITE 100A
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018
Practice Address - Country:US
Practice Address - Phone:312-421-1016
Practice Address - Fax:847-787-7144
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38428-20207Q00000X
IL036-098167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098167Medicaid
IL036098167Medicaid