Healthcare Provider Details

I. General information

NPI: 1396736237
Provider Name (Legal Business Name): COLLEEN OPREMCAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 PARKDALE DR
WEST JEFFERSON OH
43162-1043
US

IV. Provider business mailing address

146 PARKDALE DR
WEST JEFFERSON OH
43162-1043
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4318
  • Fax: 614-566-1718
Mailing address:
  • Phone: 614-566-4318
  • Fax: 614-566-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35049765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: