Provider Demographics
NPI:1306966825
Name:KOLARIK, DOUGLAS B (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:KOLARIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 KUMHO DR
Mailing Address - Street 2:STE 202
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9297
Mailing Address - Country:US
Mailing Address - Phone:330-576-0500
Mailing Address - Fax:330-576-0467
Practice Address - Street 1:822 KUMHO DR
Practice Address - Street 2:STE 202
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9297
Practice Address - Country:US
Practice Address - Phone:330-576-0500
Practice Address - Fax:330-576-0467
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089397207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000532578OtherANTHEM
OH0100000532578OtherANTHEM
OH2755880Medicaid
OH$$$$$$$$$00OtherBWC
OH2755880Medicaid
OH$$$$$$$$$001OtherMEDICAL MUTUAL