Provider Demographics
NPI:1407842701
Name:KOLLIGIAN, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:KOLLIGIAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4712 N ARMENIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2611
Mailing Address - Country:US
Mailing Address - Phone:813-874-7500
Mailing Address - Fax:813-877-1397
Practice Address - Street 1:4712 N ARMENIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2611
Practice Address - Country:US
Practice Address - Phone:813-874-7500
Practice Address - Fax:813-877-1397
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLME 10012088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2601800-00Medicaid
FL2601800-00Medicaid
FLH12576Medicare UPIN