Provider Demographics
NPI:1518096767
Name:COLLIE, ANN VIRAE (DO)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:VIRAE
Last Name:COLLIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1027
Practice Address - Country:US
Practice Address - Phone:260-266-8840
Practice Address - Fax:260-266-8849
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201775207R00000X, 207RE0101X
IN02002938A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518096767Medicaid
VA10022013OtherSENTARA/OPTIMA
IN200907500Medicaid
VA304619OtherANTHEM
NC5906049Medicaid
VA3168998OtherUHC/MAMSI