=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093514242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR COLOMBO PSYCHIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2025
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23133 WOODWARD AVE # 126
-----------------------------------------------------
City | FERNDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48220-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 947-277-7385
-----------------------------------------------------
Fax | 734-794-7166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23133 WOODWARD AVE # 126
-----------------------------------------------------
City | FERNDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48220-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 947-277-7385
-----------------------------------------------------
Fax | 734-794-7166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. OLIVIA COLOMBO
-----------------------------------------------------
Credential | DO MHA
-----------------------------------------------------
Telephone | 947-277-7385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------