Provider Demographics
NPI:1811077928
Name:COLONY MEDICAL GROUP PC
Entity type:Organization
Organization Name:COLONY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:989-790-0070
Mailing Address - Street 1:125 COLONY DRIVE NORTH
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7101
Mailing Address - Country:US
Mailing Address - Phone:989-790-0070
Mailing Address - Fax:989-249-0449
Practice Address - Street 1:125 COLONY DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7101
Practice Address - Country:US
Practice Address - Phone:989-790-0070
Practice Address - Fax:989-249-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811077928Medicare UPIN
0M54050Medicare ID - Type Unspecified