MEDICARE: KAYA COLAK MD

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	2085R0202X	Diagnostic Radiology Physician	4301061953	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301061953	OTHER	MI	MICHIGAN LICENSE NUMBER

General Provider Information

NPI Number	:	1558450023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYA COLAK MD

Provider Business Mailing Address
First Line	:	1500 E HILLSBORO BLVD
Second Line	:	STE 110
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4356
Country	:	US
Telephone Number	:	954-426-3006
Fax Number	:	954-481-9318

Provider Business Practice Location Address
First Line	:	2230 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6100
Country	:	US
Telephone Number	:	954-753-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/16/2016

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