Provider Demographics
NPI:1215386115
Name:HOLLIS, MICHAEL VERNON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VERNON
Last Name:HOLLIS
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 1:7351 E OSBORN RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6451
Mailing Address - Country:US
Mailing Address - Phone:480-324-7217
Mailing Address - Fax:
Practice Address - Street 1:2431 S M 30 STE 216
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9388
Practice Address - Country:US
Practice Address - Phone:989-343-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301508144208600000X, 208000000X
MI4301109967390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty