MEDICARE: DR. GARY M HOLLANDER DO

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	207R00000X	Internal Medicine Physician	5101012793	MI

General Provider Information

NPI Number	:	1902896749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY M HOLLANDER DO

Provider Business Mailing Address
First Line	:	620 N PONTIAC TRL
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3443
Country	:	US
Telephone Number	:	248-624-4511
Fax Number	:	248-624-4408

Provider Business Practice Location Address
First Line	:	620 N PONTIAC TRL
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3443
Country	:	US
Telephone Number	:	248-624-4511
Fax Number	:	248-624-4408

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	02/23/2010

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