Provider Demographics
NPI:1386926236
Name:HOLLAND, TREVOR J (MD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:J
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 W HARRISON ST
Mailing Address - Street 2:SUITE 466 ATRIUM
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3800
Mailing Address - Country:US
Mailing Address - Phone:312-942-5000
Mailing Address - Fax:
Practice Address - Street 1:3906 S DUPONT SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4647
Practice Address - Country:US
Practice Address - Phone:122-823-8998
Practice Address - Fax:812-282-4172
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01080516A2085R0204X
KY513902085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300019580Medicaid
IN122620051OtherMEDICARE
KY7100554940Medicaid
KYK0018657OtherMEDICARE
KYK265840OtherMEDICARE