Provider Demographics
NPI:1780651638
Name:MICHELLE E. KOLB, M.D., P.A.
Entity Type:Organization
Organization Name:MICHELLE E. KOLB, M.D., P.A.
Other - Org Name:MY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-631-7788
Mailing Address - Street 1:18055 HIGHWOODS PRESERVE PKWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1761
Mailing Address - Country:US
Mailing Address - Phone:813-631-7788
Mailing Address - Fax:813-866-9588
Practice Address - Street 1:18055 HIGHWOODS PRESERVE PKWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1761
Practice Address - Country:US
Practice Address - Phone:813-631-7788
Practice Address - Fax:813-866-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL601629208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty