Provider Demographics
NPI:1972580884
Name:INFECTIOUS DISEASE CONSULTANTS
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:TERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-831-4774
Mailing Address - Street 1:1601 E 19TH AVENUE #3650
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-831-4774
Mailing Address - Fax:303-839-7750
Practice Address - Street 1:1601 E 19TH AVENUE #3650
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-831-4774
Practice Address - Fax:303-839-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42406846Medicaid
CO36795OtherLICENSE
CO36795OtherLICENSE
COH00300Medicare UPIN