Provider Demographics
NPI:1003912346
Name:COLAN, RICHARD V (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:V
Last Name:COLAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8825 S HOWELL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3760
Mailing Address - Country:US
Mailing Address - Phone:414-762-3418
Mailing Address - Fax:414-762-3439
Practice Address - Street 1:8825 S HOWELL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3760
Practice Address - Country:US
Practice Address - Phone:414-762-3418
Practice Address - Fax:414-762-3439
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-10-03
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Provider Licenses
StateLicense IDTaxonomies
WI283332084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30831400Medicaid
WI30831400Medicaid