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General NPI Number Information
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NPI Number | 1386198976
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Entity Type | Individual
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Provider Name | CHRISTOPHER COLLAZO D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 520 VALLEY VIEW DR
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City | MOLINE
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State | IL
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Zip | 61265-6152
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Country | US
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Telephone | 309-762-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 53RD AVE STE 100
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City | BETTENDORF
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State | IA
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Zip | 52722-7565
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Country | US
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Telephone | 563-459-4005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005812
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License Number State | IL
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