Provider Demographics
NPI:1225208911
Name:GARY H COLLER DO PC
Entity Type:Organization
Organization Name:GARY H COLLER DO PC
Other - Org Name:INTEGRATIVE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-772-0700
Mailing Address - Street 1:300 S STATE ST
Mailing Address - Street 2:#5
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1676
Mailing Address - Country:US
Mailing Address - Phone:616-772-0700
Mailing Address - Fax:
Practice Address - Street 1:300 S STATE ST
Practice Address - Street 2:#5
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1676
Practice Address - Country:US
Practice Address - Phone:616-772-0700
Practice Address - Fax:616-772-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007512261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5612614Medicare PIN
MIE25893Medicare UPIN