Healthcare Provider Details

I. General information

NPI: 1174569727
Provider Name (Legal Business Name): ROBERT W HOLLENHORST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 MATTERHORN DR
DULUTH MN
55811-3812
US

IV. Provider business mailing address

5007 MATTERHORN DR
DULUTH MN
55811-3812
US

V. Phone/Fax

Practice location:
  • Phone: 218-720-3553
  • Fax: 218-786-9375
Mailing address:
  • Phone: 218-720-3553
  • Fax: 218-786-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22377
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: