Provider Demographics
NPI:1295929891
Name:COLLIER MEDICAL SPECIALISTS, INC
Entity type:Organization
Organization Name:COLLIER MEDICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:PREM
Authorized Official - Last Name:RAJANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-774-0345
Mailing Address - Street 1:6615 HILLWAY CIRCLE
Mailing Address - Street 2:STE 200
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-8755
Mailing Address - Country:US
Mailing Address - Phone:239-774-0345
Mailing Address - Fax:239-774-1783
Practice Address - Street 1:6615 HILLWAY CIR
Practice Address - Street 2:STE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-8755
Practice Address - Country:US
Practice Address - Phone:239-774-0345
Practice Address - Fax:239-774-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405284600Medicaid
MD725LJ710Medicare PIN
MD405284600Medicaid