Provider Demographics
NPI:1225152374
Name:COLLERAN, ERICA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:SUZANNE
Last Name:COLLERAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:521 WESTBURY DR STE 2
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2727
Practice Address - Country:US
Practice Address - Phone:319-339-3872
Practice Address - Fax:319-339-3874
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7829207N00000X
IAMD-37357207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2694001Medicare UPIN