MEDICARE: COLLIER MEDICAL SPECIALISTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME99073	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295929891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIER MEDICAL SPECIALISTS, INC

Provider Business Mailing Address
First Line	:	6615 HILLWAY CIRCLE
Second Line	:	STE 200
City	:	NAPLES
State	:	FL
Zip	:	34112-8755
Country	:	US
Telephone Number	:	239-774-0345
Fax Number	:	239-774-1783

Provider Business Practice Location Address
First Line	:	6615 HILLWAY CIR
Second Line	:	STE 200
City	:	NAPLES
State	:	FL
Zip	:	34112-8755
Country	:	US
Telephone Number	:	239-774-0345
Fax Number	:	239-774-1783

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. RAJEEV PREM RAJANI
Credential	:	M.D.
Telephone Number	:	239-774-0345

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	04/14/2008

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