Provider Demographics
NPI:1477715415
Name:SADLER, HOLLI TYSHANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:TYSHANN
Last Name:SADLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 15TH ST
Mailing Address - Street 2:INTERNAL MEDICINE RESIDENCY PROGRAM
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1930
Mailing Address - Country:US
Mailing Address - Phone:512-324-7000
Mailing Address - Fax:
Practice Address - Street 1:601 E 15TH STREET
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701
Practice Address - Country:US
Practice Address - Phone:512-324-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284769101Medicaid
TXTXB136218Medicare PIN