Provider Demographics
NPI:1790901072
Name:GARY HOLLANDER DO PLC
Entity Type:Organization
Organization Name:GARY HOLLANDER DO PLC
Other - Org Name:PONTIAC TRAIL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WITT-HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-624-4511
Mailing Address - Street 1:620 N PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3443
Mailing Address - Country:US
Mailing Address - Phone:248-624-4511
Mailing Address - Fax:248-624-4408
Practice Address - Street 1:620 N PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3443
Practice Address - Country:US
Practice Address - Phone:248-624-4511
Practice Address - Fax:248-624-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013058207QH0002X
MI5101012793207RH0002X
MI5601002389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Not Answered207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty