Healthcare Provider Details

I. General information

NPI: 1881693604
Provider Name (Legal Business Name): TAD REEVE HEINZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 N CIRCLE DR SUITE 115
COLORADO SPRINGS CO
80909-1163
US

IV. Provider business mailing address

2960 N CIRCLE DR SUITE 115
COLORADO SPRINGS CO
80909-1163
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-1112
  • Fax: 719-578-0128
Mailing address:
  • Phone: 719-578-1112
  • Fax: 719-578-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number37801
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number37801
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: