Provider Demographics
NPI:1922203819
Name:COLQUE, MOLLY J (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:J
Last Name:COLQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19333 W NORTH AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4132
Mailing Address - Country:US
Mailing Address - Phone:262-785-3010
Mailing Address - Fax:262-785-3648
Practice Address - Street 1:19333 W NORTH AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4132
Practice Address - Country:US
Practice Address - Phone:262-785-3010
Practice Address - Fax:262-785-3648
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55185207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29425239Medicaid
CO018232OtherKAISER COMMERCIAL NUMBER
TX8L22470Medicare PIN
COC809395Medicare PIN