Provider Demographics
NPI:1457353096
Name:HOLLANDER, MICHAEL RAND (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAND
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W KENSINGTON RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1141
Mailing Address - Country:US
Mailing Address - Phone:847-632-1155
Mailing Address - Fax:847-632-1156
Practice Address - Street 1:350 W KENSINGTON RD
Practice Address - Street 2:SUITE 114
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1141
Practice Address - Country:US
Practice Address - Phone:847-632-1155
Practice Address - Fax:847-632-1156
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-002981213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36976Medicare UPIN
IL4519350001Medicare NSC