Provider Demographics
NPI:1255391686
Name:COLON, LUIS E (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:COLON
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 1:901 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240
Mailing Address - Country:US
Mailing Address - Phone:317-844-5500
Mailing Address - Fax:317-208-2248
Practice Address - Street 1:901 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1807
Practice Address - Country:US
Practice Address - Phone:317-844-5500
Practice Address - Fax:317-208-2248
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038813A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100325970Medicaid
IN000000738436OtherANTHEM
INP01019242OtherRR MCR
INE64698Medicare UPIN
IN000000738436OtherANTHEM