Provider Demographics
NPI:1912928094
Name:HOLLANT, GLADYS EMMANUELLE (MD)
Entity type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:EMMANUELLE
Last Name:HOLLANT
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 1:1434 40TH CT
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2982
Mailing Address - Country:US
Mailing Address - Phone:262-553-9104
Mailing Address - Fax:
Practice Address - Street 1:800 55TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3733
Practice Address - Country:US
Practice Address - Phone:262-653-9286
Practice Address - Fax:262-653-9522
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine