Basic Information
| Provider Information | |||||||||
| NPI: | 1457388431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLVIN | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | MECHELE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481081633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E MEDICAL CENTER DR | ||||||||
| Address2: | 3RD FLOOR CARDIOVASCULAR CENTER | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882871082 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 04/19/2016 | ||||||||
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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 | 207R00000X | 44940 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 44940 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 4301106305 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | 4301106305 | MI | N |
ID Information
| ID | Type | State | Issuer | Description | 1671088 | 01 | MN | ARAZ | OTHER | HP38522 | 01 | MN | HEALTHPARTNERS | OTHER | 090882700 | 05 | MN | MEDICAID | 25-00021 | 01 | MN | MEDICA PRIMARY | OTHER | 0051584 | 05 | MT | MEDICAID | 25-00781 | 01 | MN | MEDICA CHOICE | OTHER | 242A0CO | 01 | MN | BCBS | OTHER | 102449 | 01 | MN | UCARE | OTHER | 1031493 | 01 | MN | PREFERRED ONE | OTHER |