Individual
JACOB COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3000 S STATE ROAD 135 STE 310, GREENWOOD, IN 46143-5527
(317) 497-2400
(317) 497-2515
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7468
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01096296A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11022090A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300063811
—
IN
Enumeration date
04/06/2022
Last updated
09/24/2025
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