MEDICARE: DR. JEAN MARIE HOLLAND M.D.

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	207N00000X	Dermatology Physician	JH041515	MI

General Provider Information

NPI Number	:	1235100470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN MARIE HOLLAND M.D.

Provider Business Mailing Address
First Line	:	14700 KING RD
Second Line	:	SUITE B
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7909
Country	:	US
Telephone Number	:	734-288-3383
Fax Number	:	734-288-3463

Provider Business Practice Location Address
First Line	:	14700 KING RD
Second Line	:	SUITE B
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7909
Country	:	US
Telephone Number	:	734-288-3383
Fax Number	:	734-288-3463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	09/17/2015

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