Healthcare Provider Details

I. General information

NPI: 1316100563
Provider Name (Legal Business Name): DAVID MICHAEL KOLLHOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 COTTONWOOD ST
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

1325 COTTONWOOD ST
WOODLAND CA
95695-5131
US

V. Phone/Fax

Practice location:
  • Phone: 312-420-5060
  • Fax:
Mailing address:
  • Phone: 312-420-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number125052092
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA122892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: