Provider Demographics
NPI:1578541447
Name:KOLANZ, M MESHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:MESHELLE
Last Name:KOLANZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MESHELLE
Other - Middle Name:
Other - Last Name:KOLANZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5881 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2910
Mailing Address - Country:US
Mailing Address - Phone:970-313-2700
Mailing Address - Fax:970-313-2727
Practice Address - Street 1:5881 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2910
Practice Address - Country:US
Practice Address - Phone:970-313-2700
Practice Address - Fax:970-313-2727
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00944876OtherMEDICARE RAILROAD CARRIER PTAN
CO01359074Medicaid
COG61674Medicare UPIN
COC21088Medicare PIN
COCOA102211Medicare PIN
COCO306620Medicare PIN