Provider Demographics
NPI:1871455865
Name:HOLLAND, LEO MACKENZIE
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:MACKENZIE
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 CEDAR PLACE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2344
Mailing Address - Country:US
Mailing Address - Phone:317-833-6871
Mailing Address - Fax:317-930-1325
Practice Address - Street 1:8555 CEDAR PLACE DR STE 114
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2344
Practice Address - Country:US
Practice Address - Phone:317-833-6871
Practice Address - Fax:317-930-1325
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-27
Last Update Date:2025-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management