Provider Demographics
NPI:1720088818
Name:COLLINS, TRACY M (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9660 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-836-5040
Mailing Address - Fax:219-836-6835
Practice Address - Street 1:9100 COLUMBIA AVENUE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2907
Practice Address - Country:US
Practice Address - Phone:219-836-5040
Practice Address - Fax:219-836-6835
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01041366A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000081279OtherANTHEM BCBS
IN100096670Medicaid
IN000000081279OtherANTHEM BCBS
IN150230BMedicare PIN