1073587689 NPI number — DAVID S HOLLANDER MD

Table of content: DAVID S HOLLANDER MD (NPI 1073587689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073587689 NPI number — DAVID S HOLLANDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLANDER
Provider First Name:
DAVID
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073587689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7595 ANAGRAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-7399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-573-2200
Provider Business Mailing Address Fax Number:
612-573-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2392 JUNIPER HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASPEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-573-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35.122503 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: DR.0033888 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 58056 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300077643 . This is a "RAILROAC MEDICARE RIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 117241700 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300090907 . This is a "RAILROAD MEDICARE DIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: XPY202951 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0421868 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104705999 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80955754 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84-059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64048549 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300093047 . This is a "RAILROAD MEDICARE MIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 02246266 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200364620 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42881401 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01338888 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200425790A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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