Basic Information
| Provider Information | |||||||||
| NPI: | 1285378232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLOMBO | ||||||||
| FirstName: | JOHN PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22250 PROVIDENCE DRIVE | ||||||||
| Address2: | 3PMB SUITE #301 (ACADEMIC INTERNAL MEDICINE DEPARTMENT) | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493281 | ||||||||
| FaxNumber: | 2488495449 | ||||||||
| Practice Location | |||||||||
| Address1: | 22250 PROVIDENCE DRIVE | ||||||||
| Address2: | 3PMB SUITE #301 (ACADEMIC INTERNAL MEDICINE DEPARTMENT) | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493281 | ||||||||
| FaxNumber: | 2488495449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2022 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 4351049399 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.