Provider Demographics
NPI:1598761827
Name:CHARLES G.COLOMBO, M.D., P.C.
Entity Type:Organization
Organization Name:CHARLES G.COLOMBO, M.D., P.C.
Other - Org Name:ORION TROY OPHTHALMOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:COLOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-293-5161
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 180
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6115
Mailing Address - Country:US
Mailing Address - Phone:248-293-5161
Mailing Address - Fax:248-293-5162
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-293-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC033296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2092585Medicaid
MI4730937Medicaid
MIB43313Medicare UPIN
MI4730937Medicaid
MI2092585Medicaid