MEDICARE: DR. HRISTO NIKOLA COLAKOVSKI 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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	208580	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639257835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HRISTO NIKOLA COLAKOVSKI M.D.

Provider Business Mailing Address
First Line	:	1880 RIDGE RD E
Second Line	:	SUITE 1B
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2473
Country	:	US
Telephone Number	:	585-266-7540
Fax Number	:	585-266-7406

Provider Business Practice Location Address
First Line	:	1880 RIDGE RD E
Second Line	:	SUITE 1B
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2473
Country	:	US
Telephone Number	:	585-266-7540
Fax Number	:	585-266-7406

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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