Provider Demographics
NPI:1699702027
Name:HOLLIS, MICHELE H (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:H
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19167 LAVAGA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23146-1557
Mailing Address - Country:US
Mailing Address - Phone:804-350-7278
Mailing Address - Fax:
Practice Address - Street 1:13860 WELLINGTON TRCE STE 38-153
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8588
Practice Address - Country:US
Practice Address - Phone:804-350-7278
Practice Address - Fax:844-374-6554
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234780207P00000X, 208M00000X
FLME108560207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101234780OtherVIRGINIA LICENSE
FLME108560OtherFLORIDA LICENSE