Individual
MATHIAS A KOLLECK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 MARY ST, EVANSVILLE, IN 47747-0001
(812) 450-7338
(812) 450-2193
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
01052471A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109144
BCBS - ER MARY STREET
IN
01
—
000000173755
BCBS - CARE GROUP MARY ST
IN
01
—
000000386245
BCBS - CARE GROUP GATEWAY
IN
05
—
64014269
—
KY
Enumeration date
07/12/2006
Last updated
07/09/2007
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