Healthcare Provider Details

I. General information

NPI: 1801885801
Provider Name (Legal Business Name): LORI B COLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST SUITE 311
COOPER CITY FL
33026-1532
US

IV. Provider business mailing address

5310 NW 33RD AVE SUITE 216
FORT LAUDERDALE FL
33309-6307
US

V. Phone/Fax

Practice location:
  • Phone: 954-435-7400
  • Fax: 954-433-5402
Mailing address:
  • Phone: 954-731-9676
  • Fax: 954-731-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME80558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: