Provider Demographics
NPI:1265498992
Name:HOLLAND, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:STE. 200-A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-7444
Practice Address - Fax:502-636-7340
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY16256208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000350759OtherANTHEM / NCMA
KY047927OtherSIHO ./ NCMA
KY2446878000OtherPASSPORT ADVANTAGE / NCMA
KY2542519OtherCIGNA / NCMA
KY64162563Medicaid
IN200510840Medicaid
KY50005575OtherPASSPORT / NCMA
KY0000284121OtherHUMANA / NCMA
KYP00181534OtherRAILROAD MEDICARE
KY50005575OtherPASSPORT / NCMA
IN200510840Medicaid