Provider Demographics
NPI:1073587689
Name:HOLLANDER, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:2392 JUNIPER HILL DR
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1225032085R0202X
CODR.00338882085R0202X
MN580562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300077643OtherRAILROAC MEDICARE RIA
WY117241700Medicaid
CO300090907OtherRAILROAD MEDICARE DIA
CAXPY202951Medicaid
OH0421868Medicaid
MI104705999Medicaid
NM80955754Medicaid
NE84-059792913Medicaid
KY64048549Medicaid
CO300093047OtherRAILROAD MEDICARE MIC
NY02246266Medicaid
CO200364620Medicaid
AZ42881401Medicaid
CO01338888Medicaid
KS200425790AMedicaid
AZ42881401Medicaid
NM80955754Medicaid
NE84-059792913Medicaid