Healthcare Provider Details

I. General information

NPI: 1437132859
Provider Name (Legal Business Name): NICHOLAS ALFRED PIANTANIDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 350
COLORADO SPRINGS CO
80910-3146
US

IV. Provider business mailing address

3027 N CIRCLE DR
COLORADO SPRINGS CO
80909-1179
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-5515
  • Fax: 719-365-1307
Mailing address:
  • Phone: 719-776-4646
  • Fax: 719-776-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0050399
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number200301159
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number50399
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: