Healthcare Provider Details

I. General information

NPI: 1558333286
Provider Name (Legal Business Name): MICHAEL J COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ELLIS PL
BOWLING GREEN KY
42104-0602
US

IV. Provider business mailing address

1340 ELLIS PL
BOWLING GREEN KY
42104-0602
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-6362
  • Fax: 270-796-2800
Mailing address:
  • Phone: 270-782-6362
  • Fax: 270-796-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19109
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number19109
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: