Provider Demographics
NPI:1124061890
Name:COLLI, JANET L (MD)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:COLLI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8625
Mailing Address - Country:US
Mailing Address - Phone:321-752-1200
Mailing Address - Fax:
Practice Address - Street 1:250 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8625
Practice Address - Country:US
Practice Address - Phone:321-752-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36064208800000X
DEC1-0025434208800000X
AL26741208800000X
TN48050208800000X
FLME80177208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110230700Medicaid
FL14TX2OtherBCBS OF FL
ALH20734OtherVIVA
AL051529990OtherBLUE CROSS
SC360647Medicaid
MS02254886OtherMISSISSIPPI MEDICAID
AL009932127Medicaid
AL009932128Medicaid
FL372641OtherAVMED
FLP01300698OtherRAILROAD MCR
AL051529989OtherBLUE CROSS
FL1881344OtherCIGNA
FL1124061890Medicaid
FL14TX2OtherBCBS OF FL
H20734Medicare UPIN