Provider Demographics
NPI:1316198328
Name:KOLOBOV, ANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:
Last Name:KOLOBOV
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 1:13607 PINE VILLA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1617
Mailing Address - Country:US
Mailing Address - Phone:239-298-6159
Mailing Address - Fax:239-210-0134
Practice Address - Street 1:2727 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9358
Practice Address - Country:US
Practice Address - Phone:239-939-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine