Healthcare Provider Details

I. General information

NPI: 1235100470
Provider Name (Legal Business Name): JEAN MARIE HOLLAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 KING RD SUITE B
RIVERVIEW MI
48193-7909
US

IV. Provider business mailing address

14700 KING RD SUITE B
RIVERVIEW MI
48193-7909
US

V. Phone/Fax

Practice location:
  • Phone: 734-288-3383
  • Fax: 734-288-3463
Mailing address:
  • Phone: 734-288-3383
  • Fax: 734-288-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberJH041515
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: