Healthcare Provider Details

I. General information

NPI: 1053570754
Provider Name (Legal Business Name): CHRISTOPHER CASEY HOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-3750
  • Fax: 708-216-6840
Mailing address:
  • Phone: 708-216-3750
  • Fax: 708-216-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number244565
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number336.090569
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: