Healthcare Provider Details

I. General information

NPI: 1689105199
Provider Name (Legal Business Name): ELENI MARIA COLLETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

9152 TAYLORSVILLE RD # 276
LOUISVILLE KY
40299-1752
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-8786
  • Fax: 502-447-8623
Mailing address:
  • Phone: 502-447-8786
  • Fax: 502-447-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01086500A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: