Provider Demographics
NPI:1326856923
Name:HOLLER-WILLESS, ZANE M (MD)
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:M
Last Name:HOLLER-WILLESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 W 850 N
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9646
Mailing Address - Country:US
Mailing Address - Phone:870-754-1574
Mailing Address - Fax:
Practice Address - Street 1:2320 W 850 N
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-9646
Practice Address - Country:US
Practice Address - Phone:870-754-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program