Provider Demographics
NPI:1356376867
Name:PHILIP COLAIZZO M.D., P.A.
Entity type:Organization
Organization Name:PHILIP COLAIZZO M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:COLAIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-575-9876
Mailing Address - Street 1:6650 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4628
Mailing Address - Country:US
Mailing Address - Phone:561-575-9876
Mailing Address - Fax:561-575-2858
Practice Address - Street 1:170 S BARFIELD HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-1876
Practice Address - Country:US
Practice Address - Phone:561-924-5155
Practice Address - Fax:561-924-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102625101Medicaid
FL102625100Medicaid
FL45348OtherBCBS