Provider Demographics
NPI:1376578997
Name:COLON, MICHELE SUMMERS (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:SUMMERS
Last Name:COLON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2607
Mailing Address - Country:US
Mailing Address - Phone:626-442-1223
Mailing Address - Fax:626-442-0439
Practice Address - Street 1:3503 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2607
Practice Address - Country:US
Practice Address - Phone:626-442-1223
Practice Address - Fax:626-442-0439
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4053213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40530Medicaid
W19196Medicare ID - Type Unspecified
CA000E40530Medicaid
U67660Medicare UPIN
CAE4053Medicare PIN
CA4725640001Medicare NSC