MEDICARE: GLEN L HOLLINGER MD A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A21645	CA

General Provider Information

NPI Number	:	1184721300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN L HOLLINGER MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1245 WISHIRE BLVD
Second Line	:	SUITE 607
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4806
Country	:	US
Telephone Number	:	213-977-0187
Fax Number	:	213-977-1312

Provider Business Practice Location Address
First Line	:	1245 WISHIRE BLVD
Second Line	:	SUITE 607
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4806
Country	:	US
Telephone Number	:	213-977-0187
Fax Number	:	213-977-1312

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLEN L HOLLINGER
Credential	:	MD
Telephone Number	:	213-977-0187

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/18/2008

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