Healthcare Provider Details

I. General information

NPI: 1588724454
Provider Name (Legal Business Name): FRANK B. HOLLOWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD UROLOGY DEPT - K9
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD UROLOGY DEPT - K9
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2062
  • Fax: 313-916-1462
Mailing address:
  • Phone: 313-916-2062
  • Fax: 313-916-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number051838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: