Provider Demographics
NPI:1912959578
Name:HOLLANDER, LAWRENCE (MD, FACS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:209 CROSSROADS PL
Mailing Address - Street 2:SUITE #130
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6254
Mailing Address - Country:US
Mailing Address - Phone:618-242-3831
Mailing Address - Fax:618-242-3375
Practice Address - Street 1:209 CROSSROADS PL
Practice Address - Street 2:SUITE #130
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6254
Practice Address - Country:US
Practice Address - Phone:618-242-3831
Practice Address - Fax:618-242-3375
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44755Medicare UPIN
ILK02935Medicare PIN