Provider Demographics
NPI:1144229279
Name:COLANTONI, WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:COLANTONI
Suffix:JR
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 1:100 E KIMBERLY RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5924
Mailing Address - Country:US
Mailing Address - Phone:563-386-3333
Mailing Address - Fax:563-386-9209
Practice Address - Street 1:100 E KIMBERLY RD
Practice Address - Street 2:SUITE 303
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5924
Practice Address - Country:US
Practice Address - Phone:563-386-3333
Practice Address - Fax:563-386-9209
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20388207N00000X
NE12808207N00000X
CAG833882207N00000X
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2131318Medicaid
B18012Medicare UPIN
IA190462Medicare ID - Type Unspecified