Basic Information
| Provider Information | |||||||||
| NPI: | 1073587689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLANDER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7595 ANAGRAM DR | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553447399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 7595 ANAGRAM DR | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553447399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35.122503 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | DR.0033888 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 58056 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0421868 | 05 | OH | MEDICAID | 200364620 | 05 | CO | MEDICAID | 200425790A | 05 | KS | MEDICAID | 01338888 | 05 | CO | MEDICAID | XPY202951 | 05 | CA | MEDICAID | 02246266 | 05 | NY | MEDICAID | 42881401 | 05 | AZ | MEDICAID | 300077643 | 01 | CO | RAILROAC MEDICARE RIA | OTHER | 300090907 | 01 | CO | RAILROAD MEDICARE DIA | OTHER | 80955754 | 05 | NM | MEDICAID | 104705999 | 05 | MI | MEDICAID | 117241700 | 05 | WY | MEDICAID | 300093047 | 01 | CO | RAILROAD MEDICARE MIC | OTHER | 64048549 | 05 | KY | MEDICAID | 84-059792913 | 05 | NE | MEDICAID |