MEDICARE: DR. KRISTAMARIE F COLLMAN M.D.

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	207Q00000X	Family Medicine Physician	ME121353	FL
2	207Q00000X	Family Medicine Physician	076490	GA
3	207Q00000X	Family Medicine Physician	0101265105	VA

General Provider Information

NPI Number	:	1578909347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTAMARIE F COLLMAN M.D.

Provider Business Mailing Address
First Line	:	341 N MAITLAND AVE STE 285
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4761
Country	:	US
Telephone Number	:	407-205-2994
Fax Number	:	407-550-3794

Provider Business Practice Location Address
First Line	:	341 N MAITLAND AVE STE 285
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4761
Country	:	US
Telephone Number	:	407-205-2994
Fax Number	:	407-550-3794

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

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	08/01/2022

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