Provider Demographics
NPI:1043383680
Name:THE KOLBE CENTER
Entity Type:Organization
Organization Name:THE KOLBE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-726-0777
Mailing Address - Street 1:1803 BROAD RIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2339
Mailing Address - Country:US
Mailing Address - Phone:317-726-0777
Mailing Address - Fax:317-726-0779
Practice Address - Street 1:1803 BROAD RIPPLE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2339
Practice Address - Country:US
Practice Address - Phone:317-726-0777
Practice Address - Fax:317-726-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036943207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN253320Medicare PIN