MEDICARE: THE KOLBE CENTER

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	01036943	IN
2	207Q00000X	Family Medicine Physician	01036943	IN

General Provider Information

NPI Number	:	1043383680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KOLBE CENTER

Provider Business Mailing Address
First Line	:	1803 BROAD RIPPLE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2339
Country	:	US
Telephone Number	:	317-726-0777
Fax Number	:	317-726-0779

Provider Business Practice Location Address
First Line	:	1803 BROAD RIPPLE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2339
Country	:	US
Telephone Number	:	317-726-0777
Fax Number	:	317-726-0779

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELANIE MARGIOTTA
Credential	:	MD
Telephone Number	:	317-726-0777

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/26/2007

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