Healthcare Provider Details

I. General information

NPI: 1043383680
Provider Name (Legal Business Name): THE KOLBE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 BROAD RIPPLE AVE
INDIANAPOLIS IN
46220-2339
US

IV. Provider business mailing address

1803 BROAD RIPPLE AVE
INDIANAPOLIS IN
46220-2339
US

V. Phone/Fax

Practice location:
  • Phone: 317-726-0777
  • Fax: 317-726-0779
Mailing address:
  • Phone: 317-726-0777
  • Fax: 317-726-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number01036943
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01036943
License Number StateIN

VIII. Authorized Official

Name: MELANIE MARGIOTTA
Title or Position: PRESIDENT
Credential: MD
Phone: 317-726-0777