Healthcare Provider Details

I. General information

NPI: 1639118839
Provider Name (Legal Business Name): ROBERT BLAINE KOLBE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/17/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 W PLYMOUTH ST
BREMEN IN
46506-1842
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-5363
  • Fax: 574-546-2575
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01031578
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: