Provider Demographics
NPI:1801857891
Name:HOLLENBECK, LARRY C (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:C
Last Name:HOLLENBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 1235
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-472-5157
Mailing Address - Fax:816-472-7201
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 1235
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-472-5157
Practice Address - Fax:816-472-7201
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6F612084N0400X
KS04-201592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3230500-0002OtherCIGNA
MO12416018OtherBLUE SHIELD
MO206664914Medicaid
MO206664906Medicaid
MO453014OtherAETNA
MO10001511401OtherCOMMUNITY HEALTH PLAN
MO0508022OtherUNITED HEALTH CARE
MO0508022OtherUNITED HEALTH CARE
MO3230500-0002OtherCIGNA
MO10001511401OtherCOMMUNITY HEALTH PLAN
MO130005786Medicare ID - Type UnspecifiedRAILROAD MEDICARE