Basic Information
| Provider Information | |||||||||
| NPI: | 1043206295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLLMAN | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 819 N 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DENNISON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446211003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409222800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 OXFORD ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306663400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 07/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35048322 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0543380 | 05 | OH | MEDICAID |