Provider Demographics
NPI:1083691521
Name:COLLINS, ROBERT HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HENRY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 SOLUTIONS CENTER
Mailing Address - Street 2:PO BOX 771270
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1002
Mailing Address - Country:US
Mailing Address - Phone:513-542-6898
Mailing Address - Fax:513-542-7972
Practice Address - Street 1:10506 MONTGOMERY ROAD
Practice Address - Street 2:STE. 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-794-1601
Practice Address - Fax:513-794-1620
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048117208600000X
OH35-0481172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH743190OtherBUCKEYE
OH0643412OtherAETNA
OH000000021293OtherANTHEM
OH020034064OtherRAILLROAD MEDICARE
OH297849OtherAMERIGROUP
OH020034064OtherRAILLROAD MEDICARE
OH0495521Medicare ID - Type Unspecified
OH743190OtherBUCKEYE
OHA15265Medicare UPIN
OHCO0521576Medicare PIN