Provider Demographics
NPI:1972894996
Name:HOLLAND WOOD, AURELIA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:AURELIA
Middle Name:CHRISTINE
Last Name:HOLLAND WOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AURELIA
Other - Middle Name:CHRISTINE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-559-9425
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:411 E CHESTNUT ST # STREET7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47360208000000X, 2080P0205X
OH35-1332492080P0205X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271161Medicaid
KY7100311230Medicaid
IN201239170Medicaid
OHH650800OtherCGS-MEDICARE