Provider Demographics
NPI:1851423875
Name:NORTH METRO INFECTIOUS DISEASE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:NORTH METRO INFECTIOUS DISEASE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:CULLINAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-522-4686
Mailing Address - Street 1:9141 GRANT ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4374
Mailing Address - Country:US
Mailing Address - Phone:303-522-4686
Mailing Address - Fax:303-980-0431
Practice Address - Street 1:9141 GRANT ST
Practice Address - Street 2:SUITE 235
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4374
Practice Address - Country:US
Practice Address - Phone:303-522-4686
Practice Address - Fax:303-980-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25375207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31482775Medicaid
CO31482775Medicaid
COC803447Medicare PIN