Healthcare Provider Details

I. General information

NPI: 1881654671
Provider Name (Legal Business Name): JAY HOLLANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD STE. 407
ROYAL OAK MI
48073-6769
US

IV. Provider business mailing address

20952 12 MILE ROAD SUITE 200
SAINT CLAIR SHORES MI
48081-3203
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0638
  • Fax: 248-551-4491
Mailing address:
  • Phone: 586-771-4820
  • Fax: 586-771-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301043235
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: