Healthcare Provider Details

I. General information

NPI: 1679555486
Provider Name (Legal Business Name): CHRISTOPHER LEE COLGLAZIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 LEGENDS WAY
CRESTVIEW HILLS KY
41017-2418
US

IV. Provider business mailing address

2616 LEGENDS WAY
CRESTVIEW HILLS KY
41017-2418
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-3100
  • Fax: 859-331-9147
Mailing address:
  • Phone: 859-331-3100
  • Fax: 859-331-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number39193
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: