Provider Demographics
NPI:1730522590
Name:EZEUKA, COLLINS (MD)
Entity type:Individual
Prefix:DR
First Name:COLLINS
Middle Name:
Last Name:EZEUKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 CLARK RD # 3072
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3227
Mailing Address - Country:US
Mailing Address - Phone:818-554-0112
Mailing Address - Fax:
Practice Address - Street 1:1949 NORTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2143
Practice Address - Country:US
Practice Address - Phone:941-208-3070
Practice Address - Fax:941-208-3067
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143828208D00000X
NY302350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice