| Doctor Name: | DR. CHARLES GEORGE COLOMBO |
| NPI Number: | 1588660807 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | CC033296 |
| Business Practice Address: | 1701 South Blvd E Ste 180 Rochester Hills, MI - 483076115 |
| Business Phone Number: | 2482935161 |
| Business Fax Number: | 2482935162 |
| Mailing Address: | 2625 Solution Ctr, CHICAGO |
| State: | IL |
| Postal Code: | 606772006 |
| Phone Number: | 2482935161 |
| Fax Number: | 2482935162 |
| NPI Enumeration Date: | 06/22/2005 |
| NPI Last Update Date: | 12/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | CC033296 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |