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General NPI Number Information
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NPI Number | 1679888945
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Entity Type | Organization
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Legal Business Name | CONSOLIDATED DOMAIN SOLUTIONS LLC
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 509 SE RIVERSIDE DR SUITE 200
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City | STUART
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State | FL
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Zip | 34994-2579
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Country | US
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Telephone | 772-283-5864
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Fax | 772-283-3830
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Provider Business Mailing Address
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Address Line | 509 SE RIVERSIDE DR SUITE 200
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City | STUART
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State | FL
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Zip | 34994-2579
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Country | US
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Telephone | 772-283-5864
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Fax | 772-283-3830
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH L HOLLING
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Credential | MD
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Telephone | 772-215-4562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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