Individual
DR. THOMAS M KOLAKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 OSOLO RD, SUITE A, ELKHART, IN 46514-4122
(574) 264-9635
(574) 262-0398
Mailing address
1506 OSOLO RD, SUITE A, ELKHART, IN 46514-4122
(574) 264-9635
(574) 262-0398
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01032267A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109324
ANTHEM BCBS #
IN
Enumeration date
07/15/2005
Last updated
02/11/2008
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