Healthcare Provider Details

I. General information

NPI: 1669578654
Provider Name (Legal Business Name): ALEXIOS-CLARK C CONSTANTINIDES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX C CONSTANTINIDES D.O.

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 N ACADEMY BLVD STE 1800
COLORADO SPRINGS CO
80918-4060
US

IV. Provider business mailing address

5265 N ACADEMY BLVD STE 1800
COLORADO SPRINGS CO
80918-4060
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-0444
  • Fax: 719-599-8809
Mailing address:
  • Phone: 719-599-0444
  • Fax: 719-599-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39699
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: