Healthcare Provider Details

I. General information

NPI: 1558450023
Provider Name (Legal Business Name): KAYA COLAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6100
US

IV. Provider business mailing address

1500 E HILLSBORO BLVD STE 110
DEERFIELD BEACH FL
33441-4356
US

V. Phone/Fax

Practice location:
  • Phone: 954-753-3800
  • Fax:
Mailing address:
  • Phone: 954-426-3006
  • Fax: 954-481-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301061953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: