MEDICARE: GARY HOLLANDER DO PLC

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	5101013058	MI
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	5101012793	MI
3	363A00000X	Physician Assistant	5601002389	MI

General Provider Information

NPI Number	:	1790901072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY HOLLANDER DO PLC

Provider Business Mailing Address
First Line	:	620 N PONTIAC TRL
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3443
Country	:	US
Telephone Number	:	248-624-4511
Fax Number	:	248-624-4408

Provider Business Practice Location Address
First Line	:	620 N PONTIAC TRL
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3443
Country	:	US
Telephone Number	:	248-624-4511
Fax Number	:	248-624-4408

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DEBBIE SUE WITT-HAGGERTY
Credential	:
Telephone Number	:	248-624-4511

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	09/11/2025

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