Individual
MR. JUSTIN ROBERT HOLLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10122 E 10TH ST, STE210, INDIANAPOLIS, IN 46229-2664
(317) 355-2230
(317) 355-2305
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
(317) 355-2184
(317) 355-2305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01070715A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11015096A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201061650
—
IN
01
—
P01197283
RR MEDICARE PTAN
IN
Enumeration date
07/14/2009
Last updated
11/27/2023
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