Provider Demographics
NPI:1891764239
Name:COLLIER, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:COLLIER
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 1:614 GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-1671
Mailing Address - Country:US
Mailing Address - Phone:972-563-7337
Mailing Address - Fax:972-563-7337
Practice Address - Street 1:614 GRIFFITH AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-1671
Practice Address - Country:US
Practice Address - Phone:972-563-7337
Practice Address - Fax:972-563-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE84002085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133968109Medicaid
84R941Medicare ID - Type Unspecified
TX133968109Medicaid
E02146Medicare UPIN
TX613970Medicare PIN