Healthcare Provider Details

I. General information

NPI: 1417692070
Provider Name (Legal Business Name): OLIVIA COLOMBO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA COLOMBO

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

23133 WOODWARD AVE # 126
FERNDALE MI
48220-1360
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6412
  • Fax:
Mailing address:
  • Phone:
  • Fax: 734-794-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number94-12948
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number51010278843
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101027843
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: