Healthcare Provider Details

I. General information

NPI: 1003270463
Provider Name (Legal Business Name): HUNTER KEGAN HOLT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 W MAXWELL ST
CHICAGO IL
60607-5002
US

IV. Provider business mailing address

1569 SLOAT BLVD
SAN FRANCISCO CA
94132-1256
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2901
  • Fax: 312-996-5181
Mailing address:
  • Phone: 415-353-9339
  • Fax: 415-353-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036158119
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: