Organization
JOSEPHINE F COLLACO MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE POLO (OPERATIONS MANAGER)
(440) 234-8833
Entity
Organization
Contact information
Practice address
1050 ISAAC STREETS DR, SUITE 104, OREGON, OH 43616-3291
(419) 698-4642
(419) 698-8597
Mailing address
7550 LUCERNE DR, SUITE 405, MIDDLEBURG HTS, OH 44130-6503
(800) 556-6236
(440) 234-3313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35038665
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000162663
ANTHEM BLUE CROSS BLUE SHIELD
OH
Enumeration date
04/25/2012
Last updated
04/25/2012
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