Provider Demographics
NPI:1396736237
Name:OPREMCAK, COLLEEN (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:OPREMCAK
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 1:146 PARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1043
Mailing Address - Country:US
Mailing Address - Phone:614-566-4318
Mailing Address - Fax:614-566-1718
Practice Address - Street 1:146 PARKDALE DR
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1043
Practice Address - Country:US
Practice Address - Phone:614-566-4318
Practice Address - Fax:614-566-1718
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350497652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0930194Medicaid
OH0750934Medicare PIN
OHF68131Medicare UPIN