Provider Demographics
NPI:1851403596
Name:KOLKIN, ALLA (MD02)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:KOLKIN
Suffix:
Gender:F
Credentials:MD02
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5260
Mailing Address - Country:US
Mailing Address - Phone:216-751-1900
Mailing Address - Fax:216-751-1970
Practice Address - Street 1:3461 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5260
Practice Address - Country:US
Practice Address - Phone:216-751-1900
Practice Address - Fax:216-751-1970
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2170341Medicaid