MEDICARE: DR. COLLEEN VICTORY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35069335	OH

General Provider Information

NPI Number	:	1033552724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN VICTORY MD

Provider Business Mailing Address
First Line	:	600 SUPERIOR AVE E
Second Line	:	SUITE 2400
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2614
Country	:	US
Telephone Number	:	216-337-1622
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SUPERIOR AVE E
Second Line	:	SUITE 2400
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2614
Country	:	US
Telephone Number	:	216-337-1622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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