Provider Demographics
NPI:1154825230
Name:CENTER POINTE FAMILY MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CENTER POINTE FAMILY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-282-6100
Mailing Address - Street 1:5410 POWERS CENTER PT STE 230
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7148
Mailing Address - Country:US
Mailing Address - Phone:719-282-6100
Mailing Address - Fax:
Practice Address - Street 1:1 OAKWOOD PARK PLZ STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1849
Practice Address - Country:US
Practice Address - Phone:719-282-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty