MEDICARE: DR. MICHAEL RAND HOLLANDER DPM

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	213E00000X	Podiatrist	016-002981	IL
2	213ES0000X	Sports Medicine Podiatrist	016-002981	IL
3	213ES0103X	Foot & Ankle Surgery Podiatrist	016-002981	IL

General Provider Information

NPI Number	:	1457353096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RAND HOLLANDER DPM

Provider Business Mailing Address
First Line	:	350 W KENSINGTON RD
Second Line	:	SUITE 114
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-632-1155
Fax Number	:	847-632-1156

Provider Business Practice Location Address
First Line	:	350 W KENSINGTON RD
Second Line	:	SUITE 114
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-632-1155
Fax Number	:	847-632-1156

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/15/2008

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