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NPI Code Detail

MEDICARE: DR. MAIDA E COLON MD

MEDICARE: DR. MAIDA E COLON 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
1207P00000XEmergency Medicine Physician24769KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000275811OTHERKYBCBS 12 DIGIT PROVIDER #
21069567OTHERKYPASSPORT GROUP # 1172544
350000550OTHERKYPASSPORT GROUP # 50000548
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5000000060164OTHERKYBCBS 12 DIGIT PROVIDER #

General Provider Information

NPI Number : 1205831674
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAIDA E COLON MD
Provider Business Mailing Address
First Line : PO BOX 8
Second Line :
City : LOUISVILLE
State : KY
Zip : 40201-0008
Country : US
Telephone Number : 800-476-8646
Fax Number : 919-382-3210
Provider Business Practice Location Address
First Line : 727 HOSPITAL DR
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-1660
Country : US
Telephone Number : 502-647-4347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 07/09/2007

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