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NPI Code Detail

MEDICARE: DR. EUGENE PAUL HOLMES PSY.D.

MEDICARE: DR. EUGENE PAUL HOLMES PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071005108IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1279826000OTHERILMAGELLAN HEALTH SERVICES
201634764OTHERILBCBSIL

General Provider Information

NPI Number : 1790861664
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EUGENE PAUL HOLMES PSY.D.
Provider Business Mailing Address
First Line : P. O. BOX 747
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-1125
Country : US
Telephone Number : 708-403-7570
Fax Number : 708-403-7546
Provider Business Practice Location Address
First Line : 1800 RAVINIA PL
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3761
Country : US
Telephone Number : 708-403-7570
Fax Number : 708-403-7546
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/30/2010

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