Provider Demographics
NPI:1194784124
Name:COLLINS, ELIZABETH KELLY (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KELLY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-922-4200
Mailing Address - Fax:952-922-4301
Practice Address - Street 1:PEDIATRIC SERVICES
Practice Address - Street 2:4700 PARK GLEN RD
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-922-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45584208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics