Individual
DR. KENNETH WINSTON HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3330 W 177TH ST, SUITE 3C, HAZEL CREST, IL 60429-2001
(708) 799-6799
Mailing address
3330 W 177TH ST, SUITE 3C, HAZEL CREST, IL 60429-2001
(708) 799-6799
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036-078410
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0363796086
—
IL
Enumeration date
04/19/2006
Last updated
12/16/2021
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