Healthcare Provider Details

I. General information

NPI: 1851706824
Provider Name (Legal Business Name): TERAH LOUISE HOLLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. TERAH LOUISE CHEATHAM

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E LINCOLNSHIRE BLVD STE 200
SPRINGFIELD IL
62703
US

IV. Provider business mailing address

PO BOX 19640
SPRINGFIELD IL
62794-9640
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-529-5914
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.143047
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: