Provider Demographics
NPI:1588957542
Name:HOLLISTER, HADYN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:HADYN
Middle Name:MICHAEL
Last Name:HOLLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HADYN
Other - Middle Name:
Other - Last Name:HOLLISTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1647 PORTSMOUTH AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4476
Mailing Address - Country:US
Mailing Address - Phone:815-768-7395
Mailing Address - Fax:
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:527 ACFAC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-5495
Practice Address - Fax:312-942-5727
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4777-320208600000X
IL125059402208600000X
IL036-1407382086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care