Provider Demographics
NPI:1679888945
Name:KENNETH L. HOLLING MD PA
Entity type:Organization
Organization Name:KENNETH L. HOLLING MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-283-5864
Mailing Address - Street 1:509 SE RIVERSIDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2579
Mailing Address - Country:US
Mailing Address - Phone:772-283-5864
Mailing Address - Fax:772-283-3830
Practice Address - Street 1:509 SE RIVERSIDE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2579
Practice Address - Country:US
Practice Address - Phone:772-283-5864
Practice Address - Fax:772-283-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty