Provider Demographics
NPI:1013046085
Name:COLLIER REGIONAL ORTHOPAEDIC
Entity Type:Organization
Organization Name:COLLIER REGIONAL ORTHOPAEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALAZSY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-393-0030
Mailing Address - Street 1:PO BOX 22958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0958
Mailing Address - Country:US
Mailing Address - Phone:216-595-9600
Mailing Address - Fax:216-595-9601
Practice Address - Street 1:950 N COLLIER BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2725
Practice Address - Country:US
Practice Address - Phone:239-393-0030
Practice Address - Fax:239-394-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92348207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4303052Medicaid
FL91108OtherBCBS OF FLORIDA
FLME92348OtherMEDICAL LICENSE
FLME92348OtherMEDICAL LICENSE