Provider Demographics
NPI:1023854833
Name:KOLLAR, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KOLLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2517
Mailing Address - Country:US
Mailing Address - Phone:216-316-0890
Mailing Address - Fax:888-505-0251
Practice Address - Street 1:8210 MACEDONIA COMMONS BLVD # 3A1096
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1860
Practice Address - Country:US
Practice Address - Phone:877-779-2873
Practice Address - Fax:888-505-0251
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner