MEDICARE: CHARLES G.COLOMBO, M.D., P.C.

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	174400000X	Specialist	CC033296	MI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598761827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES G.COLOMBO, M.D., P.C.

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	STE 180
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6115
Country	:	US
Telephone Number	:	248-293-5161
Fax Number	:	248-293-5162

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	248-293-5161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES GEORGE COLOMBO
Credential	:	M.D.
Telephone Number	:	248-293-5161

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/07/2022

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