1275535502 NPI number — DR. COLLEEN MARY ELIZABETH MURPHY MD

Table of content: DR. COLLEEN MARY ELIZABETH MURPHY MD (NPI 1275535502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275535502 NPI number — DR. COLLEEN MARY ELIZABETH MURPHY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURPHY
Provider First Name:
COLLEEN
Provider Middle Name:
MARY ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1275535502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1986 ENTERPRISE AVE APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT LAKES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60088-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-223-8755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2834 GREEN BAY RD RM 316
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60064-3091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-688-3680
Provider Business Practice Location Address Fax Number:
847-688-2700
Provider Enumeration Date:
05/31/2005

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: 207VX0000X , with the licence number:  4301044939 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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