Basic Information
| Provider Information | |||||||||
| NPI: | 1295791747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLINS | ||||||||
| FirstName: | COLETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 METROHEALTH DR | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441091900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 METROHEALTH DR | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441091900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167787800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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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 | 35067990W | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10801416 | 01 | CAQH | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | 3610861 | 01 | GROUP ASC MEDICARE | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER | P00187187 | 01 | RR MEDICARE INDIVIDUAL | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 107454 | 01 | KAISER | OTHER | 9273172 | 01 | GROUP MEDICARE | OTHER |