Healthcare Provider Details

I. General information

NPI: 1225537319
Provider Name (Legal Business Name): JEANNETTE COLON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WALL ST UNIT A
VALPARAISO IN
46383-2585
US

IV. Provider business mailing address

401 WALL ST UNIT A
VALPARAISO IN
46383-2585
US

V. Phone/Fax

Practice location:
  • Phone: 219-707-5772
  • Fax: 219-707-5758
Mailing address:
  • Phone: 219-707-5772
  • Fax: 219-707-5758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01075122A
License Number StateIN

VIII. Authorized Official

Name: DR. JEANNETTE ELISE COLON-MARIN
Title or Position: PRESIDENT
Credential: MD
Phone: 787-509-5218