Provider Demographics
NPI:1356334551
Name:COLLINS, ANN C (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:C
Last Name:COLLINS
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 1:826 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4704
Mailing Address - Country:US
Mailing Address - Phone:317-524-2266
Mailing Address - Fax:317-524-2277
Practice Address - Street 1:826 W 64TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4704
Practice Address - Country:US
Practice Address - Phone:317-524-2266
Practice Address - Fax:317-524-2277
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000219229OtherANTHEM
IN0185649OtherDEPARTMENT OF LABOR AND INDUSTRIES
IN200270640Medicaid
INH12288Medicare UPIN
IN190530AMedicare PIN
IN080186066Medicare PIN