Individual
LANCE D HOLEMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(312) 421-4821
(312) 421-4208
Mailing address
1335 W CHICAGO AVE, CHICAGO, IL 60622-5761
(312) 421-4821
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036076493
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076493
—
IL
01
—
31603527
BCBS ILLINOIS
IL
01
—
P00130149
RAILROAD MEDICARE
—
Enumeration date
03/28/2007
Last updated
06/18/2008
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