Healthcare Provider Details

I. General information

NPI: 1205761129
Provider Name (Legal Business Name): GERRIT TERRANCE HOLLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 906
CHICAGO IL
60612-3848
US

IV. Provider business mailing address

1725 W HARRISON ST STE 906
CHICAGO IL
60612-3848
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5315
  • Fax:
Mailing address:
  • Phone: 312-942-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125.088373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: