Provider Demographics
NPI:1295791747
Name:WILLINS, COLETTE (MD)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:WILLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067990W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10801416OtherCAQH
1780634279OtherGROUP NPI
3610861OtherGROUP ASC MEDICARE
CA4511OtherRR MEDICARE GROUP
D368301OtherGROUP IND DIAGNOSTICS MED
P00187187OtherRR MEDICARE INDIVIDUAL
0119204OtherGROUP MEDICAID
107454OtherKAISER
9273172OtherGROUP MEDICARE
P00187187OtherRR MEDICARE INDIVIDUAL
34-1783789OtherGROUP TIN