Healthcare Provider Details

I. General information

NPI: 1316055981
Provider Name (Legal Business Name): COLORADO NEURODIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7188 S MAGNOLIA CIR
CENTENNIAL CO
80112-6044
US

IV. Provider business mailing address

PO BOX 131
BENNETT CO
80102-0131
US

V. Phone/Fax

Practice location:
  • Phone: 303-907-4239
  • Fax: 303-644-5015
Mailing address:
  • Phone: 303-644-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number41898
License Number StateCO

VIII. Authorized Official

Name: DR. MIHAELA G ALEXANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 303-907-4239