Healthcare Provider Details

I. General information

NPI: 1053538868
Provider Name (Legal Business Name): JUSTIN JOSEPH HOLLANDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 N ROYAL DR
TRAVERSE CITY MI
49684-6984
US

IV. Provider business mailing address

5246 N ROYAL DR
TRAVERSE CITY MI
49684-6984
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-0957
  • Fax: 231-935-0960
Mailing address:
  • Phone: 231-935-0957
  • Fax: 231-935-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number5101016797
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: