Healthcare Provider Details

I. General information

NPI: 1558332015
Provider Name (Legal Business Name): GREGORY H COLBERT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 W LAWRENCE AVE
CHARLOTTE MI
48813-1442
US

IV. Provider business mailing address

436 W LAWRENCE AVE PO BOX 735
CHARLOTTE MI
48813-1442
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-0505
  • Fax:
Mailing address:
  • Phone: 517-543-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberGC001416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: