Provider Demographics
NPI:1770697856
Name:HOLLINGSWORTH, SONYA R (MD)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:R
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:B
Other - Last Name:REDETZKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11430 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3414
Mailing Address - Country:US
Mailing Address - Phone:263-518-1900
Mailing Address - Fax:
Practice Address - Street 1:1703 N TAYLOR DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1933
Practice Address - Country:US
Practice Address - Phone:920-457-4438
Practice Address - Fax:920-457-6748
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42726207Q00000X
WI49089-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34880300Medicaid