Provider Demographics
NPI:1720094295
Name:KODNER, HOLLY HIROKO (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:HIROKO
Last Name:KODNER
Suffix:
Gender:
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:PO BOX 7412061
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2061
Mailing Address - Country:US
Mailing Address - Phone:314-993-7009
Mailing Address - Fax:314-993-1535
Practice Address - Street 1:10806 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7773
Practice Address - Country:US
Practice Address - Phone:314-993-7009
Practice Address - Fax:314-993-1535
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005007773207V00000X
MO200500773207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200095618Medicaid