Provider Demographics
NPI:1356341846
Name:HOLDEN, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3825 HIGHLAND AVE SUITE 203
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-969-1167
Mailing Address - Fax:630-969-1284
Practice Address - Street 1:3825 HIGHLAND AVE SUITE 203
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-969-1167
Practice Address - Fax:630-969-1284
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036054681207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK48921Medicare PIN