Provider Demographics
NPI:1538339973
Name:MICHELE S COLON DPM A PROFESSIONAL PODIATRY CORP
Entity type:Organization
Organization Name:MICHELE S COLON DPM A PROFESSIONAL PODIATRY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:SUMMERS
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-442-1223
Mailing Address - Street 1:3503 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2607
Mailing Address - Country:US
Mailing Address - Phone:626-442-1223
Mailing Address - Fax:626-442-0439
Practice Address - Street 1:3503 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2607
Practice Address - Country:US
Practice Address - Phone:626-442-1223
Practice Address - Fax:626-442-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4053213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40530Medicaid
CAW19196Medicare PIN
CA5635790001Medicare NSC
CA000E40530Medicaid