Basic Information
| Provider Information | |||||||||
| NPI: | 1659370054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLBERN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARRISON | ||||||||
| OtherFirstName: | MELISSA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | DEPT CH 14389 | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600554389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852958108 | ||||||||
| FaxNumber: | 7852315991 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 SW JEWELL AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852955310 | ||||||||
| FaxNumber: | 7852955370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 10/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME120938 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 55633 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | S1789 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD467246 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C160767 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 297261 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 10643560-1205 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63229 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | CDR.0000056 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036.144848 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 17620 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 10717 | SD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MED-PHYS-LIC-61050 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-44868 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 427643 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.