Provider Demographics
NPI:1245259639
Name:HOLDEN, M C (MPH,MMS, PA-C)
Entity type:Individual
Prefix:MS
First Name:M
Middle Name:C
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:MPH,MMS, PA-C
Other - Prefix:MS
Other - First Name:M
Other - Middle Name:CHRISTINE
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1950 W POLK ST
Mailing Address - Street 2:PROFESSIONAL BLDG, ONCOLOGY CLINIC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-4471
Mailing Address - Fax:312-864-9593
Practice Address - Street 1:1950 W POLK ST
Practice Address - Street 2:PROFESSIONAL BLDG, 2ND FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-864-4471
Practice Address - Fax:312-864-9593
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85-000976363AM0700X
IL085-000976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical