| Doctor Name: | MICHAEL HOLLENBACK |
| NPI Number: | 1003923293 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A.-C. |
| License Number: | PA10003619 |
| Business Practice Address: | 9800 Se Sunnyside Rd Clackamas, OR - 970159750 |
| Business Phone Number: | 5036536440 |
| Business Fax Number: | |
| Mailing Address: | 11603 Se Flavel St, PORTLAND |
| State: | OR |
| Postal Code: | 972665980 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA10003619 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |