Individual
LISA MICHELLE HOLTSCLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
436 E WASHINGTON BLVD, FORT WAYNE, IN 46802-3210
(260) 209-7111
(260) 222-2835
Mailing address
30 W MONROE ST STE 1200, CHICAGO, IL 60603-2420
(312) 733-9730
(773) 866-8014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001568A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100373060
—
IN
Enumeration date
01/19/2006
Last updated
06/22/2020
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