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NPI Code Detail

MEDICARE: DR. MICHELLE M COLLINS-AUSTIN M.D.

MEDICARE: DR. MICHELLE M COLLINS-AUSTIN M.D.
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
1207Q00000XFamily Medicine Physician15341RLA
2207Q00000XFamily Medicine Physician01063237AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000806503OTHERINANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487675047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELLE M COLLINS-AUSTIN M.D.
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10515 ILLINOIS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46814-9182
Country : US
Telephone Number : 260-373-9200
Fax Number : 260-373-9219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 10/20/2022

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