Provider Demographics
NPI:1346434503
Name:COLONGO, MICHAEL (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:COLONGO
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 SHERIDAN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3657
Mailing Address - Country:US
Mailing Address - Phone:954-367-4567
Mailing Address - Fax:954-367-4569
Practice Address - Street 1:13472 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2019
Practice Address - Country:US
Practice Address - Phone:954-367-4567
Practice Address - Fax:954-367-4569
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1378237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist