Provider Demographics
NPI:1487631396
Name:HOLLISTER, WINSTON N (MD)
Entity type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:N
Last Name:HOLLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 112
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-542-9173
Practice Address - Fax:262-542-4312
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI18665207R00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30541000Medicaid
WI30541000Medicaid
WI222950006Medicare PIN
WI682300041Medicare PIN
WI017600005Medicare PIN
B53665Medicare UPIN
WI682300007Medicare PIN
WI017600045Medicare PIN
WI162450007Medicare PIN
WI132700006Medicare PIN