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NPI Code Detail

MEDICARE: MICHAEL KOLLAB

MEDICARE: MICHAEL KOLLAB
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
1101YA0400XAddiction (Substance Use Disorder) CounselorOH
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1932789922
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KOLLAB
Provider Business Mailing Address
First Line : 3214 PROSPECT AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2614
Country : US
Telephone Number : 216-910-9015
Fax Number :
Provider Business Practice Location Address
First Line : 3214 PROSPECT AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2614
Country : US
Telephone Number : 216-910-9015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2021
Last Update Date : 03/13/2025

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