Provider Demographics
NPI:1669687612
Name:KOLP, ELI (MD)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:
Last Name:KOLP
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 1:5618 NW 43RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3406
Mailing Address - Country:US
Mailing Address - Phone:352-505-5980
Mailing Address - Fax:
Practice Address - Street 1:1604 3RD STREET CIR E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221
Practice Address - Country:US
Practice Address - Phone:727-798-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 536672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry