MEDICARE: DR. KENNETH L HOLLING MD

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	ME0054425	FL
2	207RP1001X	Pulmonary Disease Physician	ME0054425	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18604	OTHER	FL	FL BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396737516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH L HOLLING MD

Provider Business Mailing Address
First Line	:	565 SE ASHLEY OAKS WAY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-2810
Country	:	US
Telephone Number	:	772-215-4562
Fax Number	:

Provider Business Practice Location Address
First Line	:	2628 SE WILLOUGHBY BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4700
Country	:	US
Telephone Number	:	772-215-4562
Fax Number	:

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	04/01/2025

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