Provider Demographics
NPI:1750463816
Name:HOLLEN, AMY CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CATHERINE
Last Name:HOLLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1525 E BELTLINE AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4598
Mailing Address - Country:US
Mailing Address - Phone:616-363-0055
Mailing Address - Fax:616-363-5180
Practice Address - Street 1:1525 E BELTLINE AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-363-0055
Practice Address - Fax:616-363-5180
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAH073382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH05849Medicare UPIN