Healthcare Provider Details

I. General information

NPI: 1003683806
Provider Name (Legal Business Name): PEAKMED COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S TEJON ST STE 100
COLORADO SPRINGS CO
80903-2001
US

IV. Provider business mailing address

6945 TUTT BLVD
COLORADO SPRINGS CO
80923-3566
US

V. Phone/Fax

Practice location:
  • Phone: 719-623-3068
  • Fax:
Mailing address:
  • Phone: 844-673-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIKAS AGARWAL
Title or Position: PRESIDENT & TREASURER
Credential:
Phone: 415-814-0927