MEDICARE: CHUCK R. COLAS, D.O., P.C.

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

General Provider Information

NPI Number	:	1861022873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHUCK R. COLAS, D.O., P.C.

Provider Business Mailing Address
First Line	:	711 SILVERMINE RD
Second Line	:
City	:	NEW CANAAN
State	:	CT
Zip	:	06840-4329
Country	:	US
Telephone Number	:	314-888-5233
Fax Number	:	203-590-8644

Provider Business Practice Location Address
First Line	:	#66, COUNTY RD. 37 #6
Second Line	:
City	:	CEDARVILLE
State	:	CA
Zip	:	96104
Country	:	US
Telephone Number	:	314-888-5233
Fax Number	:	203-590-8644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KATHLEEN MARY BERCHELMANN
Credential	:	M.D.
Telephone Number	:	314-435-6105

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	01/17/2020

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