| Infectious Disease Specialist Of Southern Colorado, Pllc | |
|
2001 Lake Ave Suite 2 Pueblo CO 81004-3538 | |
| (719) 582-8425 | |
| (888) 719-1380 |
| Full Name | Infectious Disease Specialist Of Southern Colorado, Pllc |
|---|---|
| Speciality | Clinic/center |
| Location | 2001 Lake Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Victor Nwanguma (CEO) |
| Authorized Official Contact | 7195828425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Disease Specialist Of Southern Colorado, Pllc Po Box 470238 Aurora CO 80047-0238 Ph: (719) 582-8425 | Infectious Disease Specialist Of Southern Colorado, Pllc 2001 Lake Ave Suite 2 Pueblo CO 81004-3538 Ph: (719) 582-8425 |
| NPI Number | 1922351279 |
|---|---|
| Provider Enumeration Date | 10/24/2012 |
| Last Update Date | 01/29/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922351279 | NPI | - | NPPES |
| 1336601387 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | DR51262 (Colorado) | Primary |
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