Provider Demographics
NPI:1326426107
Name:HOLLAND, THOMAS MONROE
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MONROE
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:HOLLAND
Other - Last Name:BENOIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14532 E SADDLE CLUB RD
Mailing Address - Street 2:
Mailing Address - City:BONNIE
Mailing Address - State:IL
Mailing Address - Zip Code:62816-3212
Mailing Address - Country:US
Mailing Address - Phone:314-323-9299
Mailing Address - Fax:
Practice Address - Street 1:5145 N CALIFORNIA AVE
Practice Address - Street 2:ATTN GME OFFICE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3661
Practice Address - Country:US
Practice Address - Phone:773-989-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program