MEDICARE: DORWYN C COLLIER, P.C.

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	261QX0100X	Occupational Medicine Clinic/Center	02001521A	IN
2	261QU0200X	Urgent Care Clinic/Center	02001521A	IN

General Provider Information

NPI Number	:	1568879575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORWYN C COLLIER, P.C.

Provider Business Mailing Address
First Line	:	3100 WINDSOR CT
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46514-5556
Country	:	US
Telephone Number	:	574-266-6555
Fax Number	:	574-266-6888

Provider Business Practice Location Address
First Line	:	410 N MAIN ST
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9216
Country	:	US
Telephone Number	:	574-825-3400
Fax Number	:	574-825-3424

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DORWYN CRAIG COLLIER
Credential	:	D.O.
Telephone Number	:	574-266-6555

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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