Healthcare Provider Details

I. General information

NPI: 1396748463
Provider Name (Legal Business Name): NIKHEEL SHRINIVAS KOLATKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 LONGWOOD AVE
BOSTON MA
02115-5804
US

IV. Provider business mailing address

121 COMMONWEALTH AVE APT 6
BOSTON MA
02116-2336
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-7947
  • Fax: 617-732-5764
Mailing address:
  • Phone: 617-304-9599
  • Fax: 888-406-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number219119
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: