Provider Demographics
NPI:1053303727
Name:HOLLAND, CHRISTOPHER MATTHEW (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 WOODHURST ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3369
Mailing Address - Country:US
Mailing Address - Phone:270-846-1900
Mailing Address - Fax:270-846-2919
Practice Address - Street 1:1212 WOODHURST ST
Practice Address - Street 2:UNIT B
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3369
Practice Address - Country:US
Practice Address - Phone:270-846-1900
Practice Address - Fax:270-846-2919
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY234213ES0103X, 213E00000X
KY00234213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80002348Medicaid
KY90013897OtherKYHEALTH CHOICES-DME
KY000000067936OtherBCBS
KY1221960002OtherPALMETTO GBA-DMERC
KY480026332OtherRAILROAD MEDICARE
KY1115102OtherPASSPORT
KY1221960002OtherPALMETTO GBA-DMERC
KY90013897OtherKYHEALTH CHOICES-DME