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General NPI Number Information
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NPI Number | 1801845904
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Entity Type | Individual
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Provider Name | THEODORE W COLLINS D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 135 E M35
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City | GWINN
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State | MI
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Zip | 49841-9160
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Country | US
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Telephone | 906-346-9275
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Fax |
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Provider Business Mailing Address
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Address Line | 301 EXPLORER ST
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City | GWINN
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State | MI
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Zip | 49841-2813
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Country | US
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Telephone | 906-483-1130
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Fax | 906-483-1394
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0521005
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101015879
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License Number State | MI
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