Provider Demographics
NPI:1841204625
Name:HOLLENSBE, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:HOLLENSBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:12188A N MERIDIAN ST
Practice Address - Street 2:SUITE #200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4410
Practice Address - Country:US
Practice Address - Phone:317-564-5100
Practice Address - Fax:317-564-5556
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040241A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000351008OtherANTHEM PIN NUMBER
IN340012499OtherMEDICARE RAILROAD
IN340012522OtherMEDICARE RAILROAD
IN340012508OtherMEDICARE RAILROAD
IN100194370OtherMEDICAID GROUP NUMBER
IN1487680518OtherGROUP NPI
IN100468530Medicaid
IN200288740OtherMEDICAID GROUP NUMBER
IN200288740OtherMEDICAID GROUP NUMBER
IN340012508OtherMEDICARE RAILROAD
IN340012522OtherMEDICARE RAILROAD
IN677730XXMedicare PIN