Provider Demographics
NPI:1881654671
Name:HOLLANDER, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20952 12 MILE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3203
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:STE. 407
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6769
Practice Address - Country:US
Practice Address - Phone:248-551-0638
Practice Address - Fax:248-551-4491
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-10-21
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Provider Licenses
StateLicense IDTaxonomies
MI4301043235208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1638800Medicaid
MI0E06273OtherBCBSM
MID90153OtherHAP
MI0E06273044Medicare PIN
MID90153Medicare UPIN