Individual
MICHAEL P COLLINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7100 OAKMONT BLVD STE 101, FORT WORTH, TX 76132-3908
(866) 367-8768
(817) 541-9501
Mailing address
5001 S COOPER ST STE 201, ARLINGTON, TX 76017-5993
(866) 367-8768
(817) 541-9555
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
J5557
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113290402
—
TX
05
—
113290403
—
TX
05
—
113290404
—
TX
01
—
113290405
MEDICAID OTHER
TX
05
—
113290406
—
TX
Enumeration date
09/20/2005
Last updated
06/03/2020
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