1104853688 NPI number — ANDREW R COLIN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104853688 NPI number — ANDREW R COLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLIN
Provider First Name:
ANDREW
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104853688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 NW 12TH AVE
Provider Second Line Business Mailing Address:
BOX 016960 M851
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33101-6960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-243-4029
Provider Business Mailing Address Fax Number:
305-243-8470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 NW 12TH AVE
Provider Second Line Business Practice Location Address:
BOX 016960 M851
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33101-6960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-243-4029
Provider Business Practice Location Address Fax Number:
305-243-8470
Provider Enumeration Date:
06/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME94081 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0214X , with the licence number: ME94081 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2743485-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017692300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".