Individual
DR. COLIN TALANDA FATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 ARCADE AVE STE 320, ELKHART, IN 46514-2477
(574) 523-7900
(574) 523-7909
Mailing address
3245 HEALTH DR STE 100, SOUTH BEND, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01091291A
IN
208600000X
Surgery Physician
52660
KY
208600000X
Surgery Physician
R-10033
IA
2086S0102X
Surgical Critical Care Physician
Primary
01091291A
IN
2086S0102X
Surgical Critical Care Physician
52660
KY
2086S0127X
Trauma Surgery Physician
4301505625
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300055631
—
IN
Enumeration date
06/06/2014
Last updated
10/10/2023
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