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General NPI Number Information
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NPI Number | 1215056296
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Entity Type | Individual
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Provider Name | LANCE D HOLEMON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-421-4821
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Fax | 312-421-4208
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Provider Business Mailing Address
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Address Line | 1335 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-5761
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Country | US
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Telephone | 312-421-4821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036076493
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License Number State | IL
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