Provider Demographics
NPI:1497865406
Name:ZADIKOFF, COLIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:M
Last Name:ZADIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MONTGOMERY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2198
Mailing Address - Country:US
Mailing Address - Phone:513-961-5558
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:4805 MONTGOMERY RD
Practice Address - Street 2:SUITE 410
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2198
Practice Address - Country:US
Practice Address - Phone:513-241-2370
Practice Address - Fax:513-241-6053
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0476482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
647879OtherAETNA
OH0498626Medicaid
IN200070330AMedicaid
311412447029OtherCARESOURCE
05-20156OtherUNITED HEALTHCARE
KY64781180Medicaid
5006431-002OtherCIGNA
000000019436OtherANTHEM
13889OtherNATIONWIDE HEALTH PLANS
IN200070330AMedicaid
OH0498626Medicaid
13889OtherNATIONWIDE HEALTH PLANS
IN200070330AMedicaid