Organization
PAIGE C HOLT, MD, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAIGE C HOLT MD (PRESIDENT)
(217) 414-5342
Entity
Organization
Contact information
Practice address
2502 E EMPIRE ST, SUITE C, BLOOMINGTON, IL 61704-3738
(309) 664-4444
Mailing address
2502 E EMPIRE ST, SUITE C, BLOOMINGTON, IL 61704-3738
(309) 664-4444
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036116185
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036116185
—
IL
Enumeration date
06/13/2013
Last updated
06/13/2013
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