Provider Demographics
NPI:1851592489
Name:MELVIN L. HOLLOWELL, M.D., F.A.C.S.
Entity Type:Organization
Organization Name:MELVIN L. HOLLOWELL, M.D., F.A.C.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:HOLLOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-559-5640
Mailing Address - Street 1:20905 GREENFIELD RD STE 507
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5351
Mailing Address - Country:US
Mailing Address - Phone:248-559-5640
Mailing Address - Fax:
Practice Address - Street 1:20905 GREENFIELD RD STE 507
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5351
Practice Address - Country:US
Practice Address - Phone:248-559-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18432850Medicaid
MI0634044Medicare ID - Type Unspecified
MIB43342Medicare UPIN