Provider Demographics
NPI:1457444994
Name:KOLISNYK, JOHN T (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:KOLISNYK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2598
Mailing Address - Country:US
Mailing Address - Phone:615-278-7600
Mailing Address - Fax:615-895-0275
Practice Address - Street 1:1272 GARRISON DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2598
Practice Address - Country:US
Practice Address - Phone:615-278-7600
Practice Address - Fax:615-895-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDO2225207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I032388Medicare PIN