Provider Demographics
NPI:1649248998
Name:HOLLSTEIN, WERNER (MD)
Entity type:Individual
Prefix:DR
First Name:WERNER
Middle Name:
Last Name:HOLLSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S OAKLAND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2200
Mailing Address - Country:US
Mailing Address - Phone:989-224-2338
Mailing Address - Fax:989-224-2065
Practice Address - Street 1:901 S OAKLAND ST STE 201
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2200
Practice Address - Country:US
Practice Address - Phone:989-224-2338
Practice Address - Fax:989-224-2065
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037559207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1280689Medicaid
MIC20578OtherRAILROAD MEDICARE
MI3346108Medicaid
MIC20578OtherRAILROAD MEDICARE
MIB44851Medicare UPIN