Provider Demographics
NPI:1043256167
Name:COLLOP, JOHN R (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:COLLOP
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:
Practice Address - Street 1:7300 N CANTON CENTER RD
Practice Address - Street 2:EMERGENCY MEDICINE DEPT
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1579
Practice Address - Country:US
Practice Address - Phone:734-454-8002
Practice Address - Fax:734-454-2733
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007293207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10432561167Medicaid
MI4661689Medicaid
MI4849246Medicaid
MIJC007293OtherBC/BS
MIJC007293OtherBC/BS
MI10432561167Medicaid