Basic Information
| Provider Information | |||||||||
| NPI: | 1104897685 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KERESHI | ||||||||
| FirstName: | TIBOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 S CASCADE AVE STE 140 | ||||||||
| Address2: | SUITE 3950 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809031604 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1633 MEDICAL CENTER PT | ||||||||
| Address2: | SUITE 3950 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809075700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196674139 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | DR.0059910 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.