Provider Demographics
NPI:1497839955
Name:COLLINS, NIMISHA RAVINDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMISHA
Middle Name:RAVINDRA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 S. 5TH AVE.
Mailing Address - Street 2:MENTAL HEALTH BUILDING 228 ADMINISTRATIVE SUITE
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:708-202-2328
Mailing Address - Fax:
Practice Address - Street 1:5TH AVENUE AND ROOSEVELT ROAD
Practice Address - Street 2:BLDG 228
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361131692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry