Basic Information
| Provider Information | |||||||||
| NPI: | 1174814891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO INTERVENTIONAL MEDICAL GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 BUTTERFIELD RD | ||||||||
| Address2: | 220 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605157915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252768 | ||||||||
| FaxNumber: | 8772194810 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 18TH ST | ||||||||
| Address2: | SUITE 3000 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802022499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252768 | ||||||||
| FaxNumber: | 8772194810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2011 | ||||||||
| LastUpdateDate: | 04/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | GREER | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6307252768 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 6712 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.