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NPI Code Detail

MEDICARE: NORTHSTAR NEUROLOGY OF COLORADO SPRINGS PC

MEDICARE: NORTHSTAR NEUROLOGY OF COLORADO SPRINGS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician

General Provider Information

NPI Number : 1194340414
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHSTAR NEUROLOGY OF COLORADO SPRINGS PC
Provider Business Mailing Address
First Line : PO BOX 38670
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80937-8670
Country : US
Telephone Number : 719-694-3595
Fax Number : 719-493-9936
Provider Business Practice Location Address
First Line : 3920 N UNION BLVD STE 150
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-1907
Country : US
Telephone Number : 719-694-3595
Fax Number : 719-493-9936
Authorized Official
Title or Position : MD
Name : APARNA KOMATINENI
Credential : MD
Telephone Number : 719-694-3595
Provider Enumeration Date : 06/11/2020
Last Update Date : 09/18/2023

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