Healthcare Provider Details

I. General information

NPI: 1174647671
Provider Name (Legal Business Name): ERMEL T TANSIONGCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E PIKES PEAK AVE FL 3
COLORADO SPRINGS CO
80909-6033
US

IV. Provider business mailing address

340 PRINTERS PKWY
COLORADO SPRINGS CO
80910-3190
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-6440
  • Fax: 719-630-6457
Mailing address:
  • Phone: 719-228-6635
  • Fax: 719-228-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number42048
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: