Basic Information
| Provider Information | |||||||||
| NPI: | 1427025550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLIE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 983 N COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | PERU | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469708646 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | PERU | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469701638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654728000 | ||||||||
| FaxNumber: | 2604792917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0000001608 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 02003340A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200903630 | 05 | IN | MEDICAID |