Healthcare Provider Details

I. General information

NPI: 1720060486
Provider Name (Legal Business Name): TEODOR JOHN HUZIJ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14960 WOODCARVER RD SUITE 101
COLORADO SPRINGS CO
80921-2370
US

IV. Provider business mailing address

14960 WOODCARVER RD SUITE 101
COLORADO SPRINGS CO
80921-2370
US

V. Phone/Fax

Practice location:
  • Phone: 719-694-2542
  • Fax: 719-694-2542
Mailing address:
  • Phone: 719-694-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number49211
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number49211
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: