Provider Demographics
NPI:1174814891
Name:COLORADO INTERVENTIONAL MEDICAL GROUP PC
Entity Type:Organization
Organization Name:COLORADO INTERVENTIONAL MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-725-2768
Mailing Address - Street 1:1901 BUTTERFIELD RD
Mailing Address - Street 2:220
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-7915
Mailing Address - Country:US
Mailing Address - Phone:630-725-2768
Mailing Address - Fax:877-219-4810
Practice Address - Street 1:999 18TH ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-2499
Practice Address - Country:US
Practice Address - Phone:630-725-2768
Practice Address - Fax:877-219-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67122085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty