MEDICARE: DR. CHARLES EDWARD KOLLMER 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	207X00000X	Orthopaedic Surgery Physician	ME0065222	FL

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	:	1821102047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD KOLLMER MD

Provider Business Mailing Address
First Line	:	812 W INDIAN RIVER BLVD
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32132-3429
Country	:	US
Telephone Number	:	386-426-1411
Fax Number	:	386-426-0457

Provider Business Practice Location Address
First Line	:	812 W INDIAN RIVER BLVD
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32132-3429
Country	:	US
Telephone Number	:	386-426-1411
Fax Number	:	386-426-0457

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	12/09/2010

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