Provider Demographics
NPI:1376578997
Name:COLON, MICHELE SUMMERS (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:SUMMERS
Last Name:COLON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:33 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1000
Mailing Address - Country:US
Mailing Address - Phone:626-315-5434
Mailing Address - Fax:
Practice Address - Street 1:180 OLD LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3905
Practice Address - Country:US
Practice Address - Phone:518-608-4587
Practice Address - Fax:518-608-4768
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4053213ES0103X
NYN007219213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
990005019OtherRAILROAD MEDICARE
CA000E40530Medicaid
CA000E40530Medicaid
U67660Medicare UPIN
CAE4053Medicare PIN
CA4725640001Medicare NSC