Healthcare Provider Details

I. General information

NPI: 1588957542
Provider Name (Legal Business Name): HADYN MICHAEL HOLLISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HADYN HOLLISTER M.D.

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST 527 ACFAC
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

1647 PORTSMOUTH AVE FIRST FLOOR
WESTCHESTER IL
60154-4476
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5495
  • Fax: 312-942-5727
Mailing address:
  • Phone: 815-768-7395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4777-320
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125059402
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036-140738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: