Provider Demographics
NPI:1780868265
Name:LEE R COLOSIMO MD PA
Entity Type:Organization
Organization Name:LEE R COLOSIMO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:COLOSIMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-540-3838
Mailing Address - Street 1:19411 MCKAY BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5713
Mailing Address - Country:US
Mailing Address - Phone:281-540-3838
Mailing Address - Fax:281-540-6773
Practice Address - Street 1:19411 MCKAY BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5713
Practice Address - Country:US
Practice Address - Phone:281-540-3838
Practice Address - Fax:281-540-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1636208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8511K0OtherBLUE CROSS OF TEXAS
TX00815NMedicare PIN
C14678Medicare UPIN