Provider Demographics
NPI:1477034502
Name:CRYOGAM COLORADO, LLC
Entity Type:Organization
Organization Name:CRYOGAM COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-667-9901
Mailing Address - Street 1:2216 HOFFMAN DR STE B
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4397
Mailing Address - Country:US
Mailing Address - Phone:970-667-9901
Mailing Address - Fax:970-461-7800
Practice Address - Street 1:2216 HOFFMAN DR STE B
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4397
Practice Address - Country:US
Practice Address - Phone:970-667-9901
Practice Address - Fax:970-461-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty