Individual
RONALD HOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 W 95TH ST, EVERGREEN PARK, IL 60805-2746
(708) 422-4221
(708) 422-4415
Mailing address
2961 TWO PATHS DR, WOODRIDGE, IL 60517-4512
(708) 422-4221
(708) 422-4415
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036.066295
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
036066295
IL
261QM1300X
Multi-Specialty Clinic/Center
036066295
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036033295
BLUE CROSS BLUE SHIELD
IL
05
—
036066295
—
IL
Enumeration date
11/29/2005
Last updated
02/24/2017
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