Provider Demographics
NPI:1609929314
Name:KOLB, MELVIN MAX (DO)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:MAX
Last Name:KOLB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11432 E LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4170
Mailing Address - Country:US
Mailing Address - Phone:303-750-9771
Mailing Address - Fax:
Practice Address - Street 1:11432 E LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4170
Practice Address - Country:US
Practice Address - Phone:303-750-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO238452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01238450Medicaid
CO01238450Medicaid
COD-24336Medicare UPIN