Provider Demographics
NPI:1639241441
Name:HOLLOWELL, MELVIN LAVERNE (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:LAVERNE
Last Name:HOLLOWELL
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 1:20905 GREENFIELD
Mailing Address - Street 2:#507
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-559-5640
Mailing Address - Fax:248-559-7945
Practice Address - Street 1:20905 GREENFIELD
Practice Address - Street 2:#507
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-559-5640
Practice Address - Fax:248-559-7945
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301025585208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18432850Medicaid
B43342Medicare UPIN
MI18432850Medicaid