Provider Demographics
NPI:1033653886
Name:HOLLOWELL, KEITH DELANO SR
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DELANO
Last Name:HOLLOWELL
Suffix:SR
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 1:19654 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2508
Mailing Address - Country:US
Mailing Address - Phone:313-743-5024
Mailing Address - Fax:
Practice Address - Street 1:19654 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2508
Practice Address - Country:US
Practice Address - Phone:313-743-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other