MEDICARE: CHRISTOPHER COLLACO MD PHD PA

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	207K00000X	Allergy & Immunology Physician	L3266	TX

General Provider Information

NPI Number	:	1235394727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER COLLACO MD PHD PA

Provider Business Mailing Address
First Line	:	4003 BELLAIRE BLVD
Second Line	:	G
City	:	HOUSTON
State	:	TX
Zip	:	77025-1160
Country	:	US
Telephone Number	:	713-502-7932
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 BELLAIRE BLVD
Second Line	:	SUITE G
City	:	HOUSTON
State	:	TX
Zip	:	77025-1160
Country	:	US
Telephone Number	:	281-253-3557
Fax Number	:

Authorized Official
Title or Position	:	OWER/PHYSICIAN
Name	:	CHRISTOPHER COLLACO
Credential	:	MD PHD
Telephone Number	:	713-502-7932

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	07/24/2008

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