Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 5101016797 | MI |
NPI | 1053538868 |
---|---|
Provider Name | Dr. Justin Joseph Hollander |
First Address | Traverse City, MI 49684-6984 |
Second Address | Traverse City, MI 49684-6984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 21/12/2020 |