Provider Demographics
NPI:1770752859
Name:MICHAEL R. HOLLANDER, DPM, PC
Entity type:Organization
Organization Name:MICHAEL R. HOLLANDER, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-632-1155
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4519350001Medicare NSC