MEDICARE: KALI HOLLINGSWORTH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	34-010558	OH
2	207Q00000X	Family Medicine Physician	34.010558	OH

General Provider Information

NPI Number	:	1245565944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALI HOLLINGSWORTH D.O.

Provider Business Mailing Address
First Line	:	6438 WILMINGTON PIKE STE 100
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-7021
Country	:	US
Telephone Number	:	937-558-3840
Fax Number	:	937-558-3844

Provider Business Practice Location Address
First Line	:	6438 WILMINGTON PIKE STE 100
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-7021
Country	:	US
Telephone Number	:	937-558-3840
Fax Number	:	937-558-3844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	01/21/2021

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