MEDICARE: PAUL MARCUS KOLON LMSW

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	104100000X	Social Worker	6801033155	MI

General Provider Information

NPI Number	:	1578525077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MARCUS KOLON LMSW

Provider Business Mailing Address
First Line	:	404 HAZEN ST
Second Line	:
City	:	PAW PAW
State	:	MI
Zip	:	49079-1040
Country	:	US
Telephone Number	:	269-657-1595
Fax Number	:	269-657-1534

Provider Business Practice Location Address
First Line	:	404 HAZEN ST
Second Line	:
City	:	PAW PAW
State	:	MI
Zip	:	49079-1040
Country	:	US
Telephone Number	:	269-657-1559
Fax Number	:	269-657-1534

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/22/2015

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