MEDICARE: OPTUMCARE COLORADO MEDICAL GROUP LLC

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1528190295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUMCARE COLORADO MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	2 S CASCADE AVE
Second Line	:	SUITE 140
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1653
Country	:	US
Telephone Number	:	719-538-2900
Fax Number	:	719-538-2961

Provider Business Practice Location Address
First Line	:	1615 MEDICAL CENTER POINT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-1906
Country	:	US
Telephone Number	:	719-636-3555
Fax Number	:	719-667-4222

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DAVID I COHEN
Credential	:
Telephone Number	:	702-480-2550

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	03/07/2024

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