Provider Demographics
NPI:1649807488
Name:HALLER, COLLEEN (DO)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:HALLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2545
Mailing Address - Country:US
Mailing Address - Phone:773-751-7800
Mailing Address - Fax:833-471-5836
Practice Address - Street 1:8320 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2545
Practice Address - Country:US
Practice Address - Phone:773-751-7800
Practice Address - Fax:833-471-5836
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.172660208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics