Provider Demographics
NPI:1881306033
Name:COLORADO MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:COLORADO MEDICAL GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:N
Authorized Official - Last Name:WAZNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-991-6117
Mailing Address - Street 1:3810 NORTHDALE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1871
Mailing Address - Country:US
Mailing Address - Phone:831-321-4906
Mailing Address - Fax:
Practice Address - Street 1:5657 S HIMALAYA ST STE 210
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5309
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty