Healthcare Provider Details

I. General information

NPI: 1811077928
Provider Name (Legal Business Name): COLONY MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COLONY DRIVE NORTH
SAGINAW MI
48638-7101
US

IV. Provider business mailing address

125 COLONY DRIVE NORTH
SAGINAW MI
48638-7101
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-0070
  • Fax: 989-249-0449
Mailing address:
  • Phone: 989-790-0070
  • Fax: 989-249-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE ADAM CALABRESE JR.
Title or Position: PRESIDENT
Credential: DO
Phone: 989-790-0070