Provider Demographics
NPI:1558417394
Name:INFECTIOUS DISEASE CONSULTANTS
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS
Other - Org Name:INFECTIOUS DISEASE CONSULTANTS, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-831-4774
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:3700
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1220
Mailing Address - Country:US
Mailing Address - Phone:303-831-4774
Mailing Address - Fax:303-839-7750
Practice Address - Street 1:1601 E 19TH AVE STE 3700
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1220
Practice Address - Country:US
Practice Address - Phone:303-831-4774
Practice Address - Fax:303-893-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04019634Medicaid
CO04019634Medicaid