Healthcare Provider Details

I. General information

NPI: 1336101765
Provider Name (Legal Business Name): COLORADO SPRINGS ENDOCRINE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E FONTANERO ST COLORADO SPRINGS ENDOCRINE CLINIC PC
COLORADO SPRINGS CO
80907-7533
US

IV. Provider business mailing address

325 E FONTANERO ST COLORADO SPRINGS ENDOCRINE CLINIC PC
COLORADO SPRINGS CO
80907-7533
US

V. Phone/Fax

Practice location:
  • Phone: 719-636-3829
  • Fax: 719-633-8571
Mailing address:
  • Phone: 719-636-3829
  • Fax: 719-633-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN E HENLEY
Title or Position: CORPORATE PRESIDENT
Credential: MD
Phone: 719-636-3829