Provider Demographics
NPI:1568441327
Name:HOLMES, GEORGE B (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:B
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:#240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 W. HARRISON
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-431-3400
Practice Address - Fax:312-986-0105
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084263207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4408127OtherAETNA
IL207067OtherMEDICARE PTAN LOCALITY #16
ILP00239374OtherRR MEDICARE PROVIDER NUMBER
IL036084263Medicaid
IL207073OtherMEDICARE PTAN LOCALITY #15
ILDA4902OtherRR MEDICARE PTAN NUMBER
IL1633878OtherBCBS ILLINOIS
ILA53311Medicare UPIN
ILK01200Medicare PIN
IL207067OtherMEDICARE PTAN LOCALITY #16