Provider Demographics
NPI:1568410199
Name:COLIADIS, KOULA S (MD)
Entity Type:Individual
Prefix:
First Name:KOULA
Middle Name:S
Last Name:COLIADIS
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 1:2588 ELM RD NE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9353
Mailing Address - Country:US
Mailing Address - Phone:330-841-5800
Mailing Address - Fax:330-841-5858
Practice Address - Street 1:2588 ELM RD NE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9353
Practice Address - Country:US
Practice Address - Phone:330-841-5800
Practice Address - Fax:330-841-5858
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0660072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2036951Medicaid
OHCO0826842Medicare PIN
OHG54915Medicare UPIN