Individual
MR. MICAH JOSEPH HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, PES, CES
Contact information
Practice address
205 W WACKER DR, SUITE 1020, CHICAGO, IL 60606-1216
(312) 640-0329
Mailing address
602 E SOPER ST, WINNEBAGO, IL 61088-9770
(815) 222-1339
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096002501
IL
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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