Provider Demographics
NPI:1902891542
Name:HOLLINGSWORTH, ANNE THERESE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:THERESE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8733 W 400 N
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9330
Mailing Address - Country:US
Mailing Address - Phone:219-929-7917
Mailing Address - Fax:219-395-1643
Practice Address - Street 1:301 JONES CT
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2690
Practice Address - Country:US
Practice Address - Phone:219-929-7917
Practice Address - Fax:219-395-1643
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010753207R00000X
IN02001394A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F58622Medicare UPIN