Provider Demographics
NPI:1013262138
Name:OUILLETTE, HOLLY (MD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:OUILLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22151 MOROSS RD STE 313
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2197
Mailing Address - Country:US
Mailing Address - Phone:313-343-3484
Mailing Address - Fax:313-343-4932
Practice Address - Street 1:22151 MOROSS RD STE 313
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2197
Practice Address - Country:US
Practice Address - Phone:313-343-3484
Practice Address - Fax:313-343-4932
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111847207VG0400X
TXQ7940207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology