Healthcare Provider Details

I. General information

NPI: 1124113121
Provider Name (Legal Business Name): SHIREEN J RUDDEROW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MEDICAL CENTER POINT
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-636-2999
  • Fax: 719-667-4108
Mailing address:
  • Phone: 719-278-3672
  • Fax: 719-623-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0050089
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: