Healthcare Provider Details

I. General information

NPI: 1982923066
Provider Name (Legal Business Name): GRETCHEN GARBE COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 RICHMOND RD
BEACHWOOD OH
44122-6046
US

IV. Provider business mailing address

1286 KEIM CT
GENEVA IL
60134-7514
US

V. Phone/Fax

Practice location:
  • Phone: 216-285-5039
  • Fax:
Mailing address:
  • Phone: 630-992-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125057880
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: