Basic Information
| Provider Information | |||||||||
| NPI: | 1417120247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLOMBO | ||||||||
| FirstName: | ROSARIO | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLOMBO | ||||||||
| OtherFirstName: | RUSS | ||||||||
| OtherMiddleName: | ANTONIO | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1801 NW 9TH AVE | ||||||||
| Address2: | SUITE #209 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864668490 | ||||||||
| FaxNumber: | 3055736562 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 NW 9TH AVE | ||||||||
| Address2: | SUITE #209 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864668490 | ||||||||
| FaxNumber: | 3055736562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2008 | ||||||||
| LastUpdateDate: | 09/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME119835 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | ME119835 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.