Carol Fundak Collins, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

64677 Issued in OH

Practice address

650 Miller Rd
Avon Lake, OH 44012-2307

Phone

(440) 933-1099

Fax

(440) 933-1040

NPI assigned

Sep 26, 2011

Last updated

Sep 26, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316995200000",
    "number": "1932482965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 MILLER ROAD",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "44012",
            "telephone_number": "440-933-1099",
            "fax_number": "440-933-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 MILLER RD",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440122307",
            "telephone_number": "440-933-1099",
            "fax_number": "440-933-1040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "CAROL",
        "middle_name": "FUNDAK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-26",
        "last_updated": "2011-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "64677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Avon Lake (Avon Lake Fire Department)
• Clarity Health and Living
• Cleveland Clinic
• Cleveland Clinic Foundation (Cleveland Clinic Avon Lake)
• Cleveland Clinic Optometry Avon
• Amber D Cooley
• Megan Marie Cox, M.A., SLP-CCC
• Gina Croft, MPT
• Crooked River Psychology Associates Inc.
• Jenna D'Orazio

• Internal Medicine Physician in Avon Lake, OH
• Providers in Avon Lake, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.