# JOSEPHINE F COLLACO MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427316637
- **Authorized official:** MIKE POLO (OPERATIONS MANAGER)
- **Authorized official phone:** (440) 234-8833

## Contact information

- **Practice address:** 1050 ISAAC STREETS DR, SUITE 104, OREGON, OH 43616-3291
- **Practice address phone:** (419) 698-4642
- **Practice address fax:** (419) 698-8597
- **Mailing address:** 7550 LUCERNE DR, SUITE 405, MIDDLEBURG HTS, OH 44130-6503
- **Mailing address phone:** (800) 556-6236
- **Mailing address fax:** (440) 234-3313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 35038665 | OH | Yes |

## Other

- **Enumeration date:** 04/25/2012
- **Last updated:** 04/25/2012