Provider Demographics
NPI:1790028207
Name:HOLLENBECK, ANDREW NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NICHOLAS
Last Name:HOLLENBECK
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 1:521 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2266
Mailing Address - Country:US
Mailing Address - Phone:231-487-1900
Mailing Address - Fax:231-348-0984
Practice Address - Street 1:4201 ST. ANTOINE
Practice Address - Street 2:6-C UNIVERSITY HEALTH CENTER DEPARTMENT OF SURGERY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-577-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
MI4301103734208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program