MEDICARE: CYNTHIA L COLLAWN MD

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	174400000X	Specialist	ME69273	FL

General Provider Information

NPI Number	:	1730166000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA L COLLAWN MD

Provider Business Mailing Address
First Line	:	1219 S EAST AVE
Second Line	:	SUITE 101
City	:	SARASOTA
State	:	FL
Zip	:	34239-2340
Country	:	US
Telephone Number	:	941-954-4373
Fax Number	:	941-954-4375

Provider Business Practice Location Address
First Line	:	1219 S EAST AVE
Second Line	:	SUITE 101
City	:	SARASOTA
State	:	FL
Zip	:	34239-2351
Country	:	US
Telephone Number	:	941-954-4373
Fax Number	:	941-954-4375

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	08/06/2008

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